Provider Demographics
NPI:1245239953
Name:OOSTERBAAN, HANS (OD)
Entity Type:Individual
Prefix:DR
First Name:HANS
Middle Name:
Last Name:OOSTERBAAN
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 1:1102 NORTH LLANO STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-5449
Mailing Address - Country:US
Mailing Address - Phone:830-997-0131
Mailing Address - Fax:866-897-9855
Practice Address - Street 1:1102 NORTH LLANO STREET
Practice Address - Street 2:SUITE A
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-5449
Practice Address - Country:US
Practice Address - Phone:830-997-0131
Practice Address - Fax:866-897-9855
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4526TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093435802Medicaid
TX0994820001Medicare NSC
TX00E83NMedicare PIN
TXB135339Medicare PIN
TX093435802Medicaid