Provider Demographics
NPI:1417902677
Name:HAHN, ANGELA (OD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:HAHN
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 1:310 W LAKE MEAD PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-7099
Mailing Address - Country:US
Mailing Address - Phone:702-550-2020
Mailing Address - Fax:702-665-4103
Practice Address - Street 1:310 W LAKE MEAD PKWY STE 120
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-7099
Practice Address - Country:US
Practice Address - Phone:702-550-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV394152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100507722Medicaid
NVV08357Medicare UPIN
NV100507722Medicaid