Provider Demographics
NPI:1265816490
Name:JACK L NEELY AND HOLLY L HANBAUM PTR
Entity Type:Organization
Organization Name:JACK L NEELY AND HOLLY L HANBAUM PTR
Other - Org Name:NEELY AND HANBAUM OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:NEELY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:740-366-5050
Mailing Address - Street 1:1010 N 21ST ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-2984
Mailing Address - Country:US
Mailing Address - Phone:740-366-5050
Mailing Address - Fax:
Practice Address - Street 1:1010 N 21ST ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-2984
Practice Address - Country:US
Practice Address - Phone:740-366-5050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty