Provider Demographics
NPI:1013190800
Name:HANLON, IRA JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:JOSEPH
Last Name:HANLON
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 1:434 HIGHWAY 18
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-2374
Mailing Address - Country:US
Mailing Address - Phone:732-613-1500
Mailing Address - Fax:732-238-4357
Practice Address - Street 1:434 HIGHWAY 18
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-2374
Practice Address - Country:US
Practice Address - Phone:732-613-1500
Practice Address - Fax:732-238-4357
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-14
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00433900152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU01546Medicare UPIN
NJHA452963Medicare PIN