Provider Demographics
NPI:1952152878
Name:HAMMOND, KENNETH (ABO, LDO)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:HAMMOND
Suffix:
Gender:M
Credentials:ABO, LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 RIVERVIEW RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-6719
Mailing Address - Country:US
Mailing Address - Phone:757-897-6145
Mailing Address - Fax:
Practice Address - Street 1:731 E ROCHAMBEAU DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2187
Practice Address - Country:US
Practice Address - Phone:757-220-8548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101000790156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician