Provider Demographics
NPI:1558657585
Name:HAMMONS, TREVOR GLEN (OD)
Entity type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:GLEN
Last Name:HAMMONS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:803 S BLUFF ST
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-5202
Mailing Address - Country:US
Mailing Address - Phone:435-628-4464
Mailing Address - Fax:435-628-5015
Practice Address - Street 1:803 S BLUFF ST
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-5202
Practice Address - Country:US
Practice Address - Phone:435-628-4464
Practice Address - Fax:435-628-5015
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8020418-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist