Healthcare Provider Details

I. General information

NPI: 1598020422
Provider Name (Legal Business Name): JOSEPH MICHAEL HAMMOND O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2012
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 POPLAR LEVEL RD
LOUISVILLE KY
40213-1524
US

IV. Provider business mailing address

2110 S HURSTBOURNE PKWY
LOUISVILLE KY
40220-1622
US

V. Phone/Fax

Practice location:
  • Phone: 502-459-2020
  • Fax: 502-456-9121
Mailing address:
  • Phone: 502-491-2232
  • Fax: 502-499-2700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18003736A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1887DT
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: