Provider Demographics
NPI:1205827177
Name:HANLEY, MARK A (OD)
Entity Type:Individual
Prefix:MRS
First Name:MARK
Middle Name:A
Last Name:HANLEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3810 S COOPER ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-4149
Mailing Address - Country:US
Mailing Address - Phone:817-557-3952
Mailing Address - Fax:817-557-1030
Practice Address - Street 1:3810 S COOPER ST
Practice Address - Street 2:SUITE 120
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-4149
Practice Address - Country:US
Practice Address - Phone:817-557-3952
Practice Address - Fax:817-557-1030
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3637TG152W00000X
LA1022152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U36385Medicare UPIN