Provider Demographics
NPI:1417949181
Name:HANSON, STANLEY DEAN (OD)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:DEAN
Last Name:HANSON
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 1:850 E HARVARD AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5073
Mailing Address - Country:US
Mailing Address - Phone:303-777-8551
Mailing Address - Fax:303-777-8435
Practice Address - Street 1:850 E HARVARD AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5073
Practice Address - Country:US
Practice Address - Phone:303-777-8551
Practice Address - Fax:303-777-8435
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO899152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08008997Medicaid
COT95394Medicare UPIN
CO79303Medicare ID - Type Unspecified