Provider Demographics
NPI:1083664114
Name:HANKIN, BRUCE R (OD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:R
Last Name:HANKIN
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 1:2160 PENFIELD RD
Mailing Address - Street 2:SUITE #100
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-1712
Mailing Address - Country:US
Mailing Address - Phone:585-377-7090
Mailing Address - Fax:585-377-3155
Practice Address - Street 1:2160 PENFIELD RD
Practice Address - Street 2:SUITE #100
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-1712
Practice Address - Country:US
Practice Address - Phone:585-377-7090
Practice Address - Fax:585-377-3155
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT004041152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY100135CSOtherPREFERRED CARE
NY1568685113OtherMEDICARE NSC
NY5474311OtherAETNA
T25911Medicare UPIN
NY1568685113Medicare NSC
NY5474311OtherAETNA