Provider Demographics
NPI:1285628412
Name:HANSEN, STEVEN E (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:E
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 1:3545 LINCOLN WAY E
Mailing Address - Street 2:SUITE A
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-8624
Mailing Address - Country:US
Mailing Address - Phone:330-837-5191
Mailing Address - Fax:330-837-0755
Practice Address - Street 1:3545 LINCOLN WAY E
Practice Address - Street 2:SUITE A
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-8624
Practice Address - Country:US
Practice Address - Phone:330-837-5191
Practice Address - Fax:330-837-0755
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4354 T260152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0951242Medicaid
OHHA0799342Medicare ID - Type Unspecified
OH0951242Medicaid