Provider Demographics
NPI:1275686842
Name:HANSEN, MICHAEL A (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:HANSEN
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 1:1540 LAKE ELMO DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-1797
Mailing Address - Country:US
Mailing Address - Phone:406-245-2299
Mailing Address - Fax:406-245-8302
Practice Address - Street 1:1540 LAKE ELMO DR
Practice Address - Street 2:SUITE 1
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105-1797
Practice Address - Country:US
Practice Address - Phone:406-245-2299
Practice Address - Fax:406-245-8302
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT419152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT4892790001OtherMEDICARE DME
MTP00040225OtherRAILROAD MEDICARE
MT26350OtherBCBS OF MT
MTMT0419OtherEYEMED VISION CARE
MT0482851Medicaid
MT000025096Medicare ID - Type Unspecified
MTMT0419OtherEYEMED VISION CARE
MT4892790001OtherMEDICARE DME