Provider Demographics
NPI:1265831564
Name:HAKANEN, CORY HAYES (OD)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:HAYES
Last Name:HAKANEN
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 1:1350 TRAVIS BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-3432
Mailing Address - Country:US
Mailing Address - Phone:707-423-9380
Mailing Address - Fax:707-423-9393
Practice Address - Street 1:1350 TRAVIS BLVD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-3432
Practice Address - Country:US
Practice Address - Phone:707-423-9380
Practice Address - Fax:707-423-9393
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15019152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF2070829OtherDRIVER'S LICENSE