Provider Demographics
NPI:1326119223
Name:HANEN SMITH, MICHEL E (OD, MS)
Entity Type:Individual
Prefix:DR
First Name:MICHEL
Middle Name:E
Last Name:HANEN SMITH
Suffix:
Gender:M
Credentials:OD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4323 E LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-2307
Mailing Address - Country:US
Mailing Address - Phone:612-722-1003
Mailing Address - Fax:612-721-6336
Practice Address - Street 1:4323 E LAKE ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-2307
Practice Address - Country:US
Practice Address - Phone:612-722-1003
Practice Address - Fax:612-721-6331
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLD1652000152W00000X, 152WC0802X, 152WX0102X
ND362152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN06314HAOtherCLINIC BCBS
MN2115985OtherMEDICAL DISP
MN19312OtherPIN HEALTH PARTNERS
MN333023100Medicaid
MN101856OtherUCARE
0748240001OtherDURABLE GOODS DMERC
MN2202001OtherMEDICA PRIMARY
MN00621001OtherPREFERRED ONE
MN2202691OtherMODIRA UNITED HEALTH CARE
WI411459852017OtherBSBC OF WI
MN5C003HAOtherBLUE PLUS
MN3M197HAOtherPROVIDER BCBS
MN2115985OtherMEDICAL DISP
WI411459852017OtherBSBC OF WI