Provider Demographics
NPI:1134117401
Name:HANSTED, THOMAS S (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:S
Last Name:HANSTED
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 1:620 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4112
Mailing Address - Country:US
Mailing Address - Phone:701-255-4673
Mailing Address - Fax:701-255-4934
Practice Address - Street 1:620 N 9TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4112
Practice Address - Country:US
Practice Address - Phone:701-255-4673
Practice Address - Fax:701-255-4934
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND555152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND860555OtherBCBS VISION SERVICES
ND19458OtherBLUE CROSS BLUE SHIELD
SD9201710Medicaid
ND60497Medicaid
NDU61978Medicare UPIN
SD9201710Medicaid