Provider Demographics
NPI:1306036421
Name:HANSSON, ANDERS SVEN (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDERS
Middle Name:SVEN
Last Name:HANSSON
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 1:1432 PARK ST
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4510
Mailing Address - Country:US
Mailing Address - Phone:510-769-2020
Mailing Address - Fax:510-769-7912
Practice Address - Street 1:1432 PARK ST
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4510
Practice Address - Country:US
Practice Address - Phone:510-769-2020
Practice Address - Fax:510-769-7912
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5720152W00000X
CA13657152W00000X
VA0618001899152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA121032Medicare PIN