Provider Demographics
NPI:1215178629
Name:HANSON, MARTIN B
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:B
Last Name:HANSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44332 STERLING HWY
Mailing Address - Street 2:SUITE #18
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-8066
Mailing Address - Country:US
Mailing Address - Phone:907-260-9199
Mailing Address - Fax:907-260-9189
Practice Address - Street 1:44332 STERLING HWY
Practice Address - Street 2:SUITE #18
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-8066
Practice Address - Country:US
Practice Address - Phone:907-260-9199
Practice Address - Fax:907-260-9189
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK215156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician