Provider Demographics
NPI:1376985507
Name:EASTMAN FAWCETT, HANNAH (OD)
Entity Type:Individual
Prefix:DR
First Name:HANNAH
Middle Name:
Last Name:EASTMAN FAWCETT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:HANNAH
Other - Middle Name:LYNN
Other - Last Name:EASTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:22141 ELTON DR
Mailing Address - Street 2:
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546-8542
Mailing Address - Country:US
Mailing Address - Phone:337-329-2468
Mailing Address - Fax:
Practice Address - Street 1:339 W PRIEN LAKE RD
Practice Address - Street 2:SUITE 200B
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8452
Practice Address - Country:US
Practice Address - Phone:337-366-0905
Practice Address - Fax:337-474-1409
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-30
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1649-683T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist