Provider Demographics
NPI:1053475483
Name:HANSON, CHRIS J (OD)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:J
Last Name:HANSON
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:PO BOX 286
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-0286
Mailing Address - Country:US
Mailing Address - Phone:262-255-6895
Mailing Address - Fax:262-255-6982
Practice Address - Street 1:W156N11048 PILGRIM RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-4247
Practice Address - Country:US
Practice Address - Phone:262-255-6895
Practice Address - Fax:262-255-6982
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1537152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000087068OtherPTAN
WIT61908Medicare UPIN
WI000087068OtherPTAN