Provider Demographics
NPI:1235266628
Name:DR. GREG HANSEN, P.C.
Entity Type:Organization
Organization Name:DR. GREG HANSEN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-582-3173
Mailing Address - Street 1:4200 DODGE ST
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52003-2624
Mailing Address - Country:US
Mailing Address - Phone:563-582-3173
Mailing Address - Fax:
Practice Address - Street 1:4200 DODGE ST
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52003-2624
Practice Address - Country:US
Practice Address - Phone:563-582-3173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1941 AND 2010152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1487616736OtherNPI FOR GREG
IAU40240Medicare UPIN
IAI9810Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
IA513416Medicare ID - Type UnspecifiedMEDICARE NUMBER FOR LISA
IAI9810Medicare ID - Type UnspecifiedGROUP NO. FOR GREG, LISA
IA52116Medicare ID - Type Unspecified
IAU02964Medicare UPIN