Provider Demographics
NPI:1093713851
Name:HANSON, BERNIE HP (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNIE
Middle Name:HP
Last Name:HANSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 29TH ST SE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-9120
Mailing Address - Country:US
Mailing Address - Phone:605-520-3528
Mailing Address - Fax:605-578-6021
Practice Address - Street 1:1425 MICKELSON DR.
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-6827
Practice Address - Country:US
Practice Address - Phone:605-599-7411
Practice Address - Fax:605-578-6021
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0963207W00000X, 156FC0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
20521OtherSIOUX VALLEY HEALTH
SD6300052Medicaid
20521OtherSIOUX VALLEY HEALTH
8350Medicare ID - Type Unspecified
D25314Medicare UPIN