Provider Demographics
NPI:1093866899
Name:HATHAWAY, RODNEY ALAN (OD PHD)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:ALAN
Last Name:HATHAWAY
Suffix:
Gender:M
Credentials:OD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15175 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161
Mailing Address - Country:US
Mailing Address - Phone:734-243-0370
Mailing Address - Fax:
Practice Address - Street 1:15175 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-5038
Practice Address - Country:US
Practice Address - Phone:734-243-0370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002726152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5085557Medicaid
MI5085557Medicaid