Provider Demographics
NPI:1326024605
Name:HANSON, JULIE ANN (OD)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANN
Last Name:HANSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 W UPTON AVE
Mailing Address - Street 2:
Mailing Address - City:REED CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49677-1130
Mailing Address - Country:US
Mailing Address - Phone:231-832-3218
Mailing Address - Fax:231-832-3628
Practice Address - Street 1:142 W UPTON AVE
Practice Address - Street 2:
Practice Address - City:REED CITY
Practice Address - State:MI
Practice Address - Zip Code:49677-1130
Practice Address - Country:US
Practice Address - Phone:231-832-3218
Practice Address - Fax:231-832-3628
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004237152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4734121Medicaid
MIOP11250002Medicare ID - Type Unspecified
MI4734121Medicaid