Provider Demographics
NPI:1770709966
Name:HAMMOND, THEODORE G (OD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:G
Last Name:HAMMOND
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47626 CHERYL CT
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-4708
Mailing Address - Country:US
Mailing Address - Phone:586-322-3523
Mailing Address - Fax:
Practice Address - Street 1:47626 CHERYL CT
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-4708
Practice Address - Country:US
Practice Address - Phone:586-322-3523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2807152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist