Provider Demographics
NPI:1447741962
Name:EDWARD, HANNAH (OD)
Entity Type:Individual
Prefix:DR
First Name:HANNAH
Middle Name:
Last Name:EDWARD
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 1:369 REVOLUTION DR
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-1553
Mailing Address - Country:US
Mailing Address - Phone:617-864-7005
Mailing Address - Fax:857-400-0712
Practice Address - Street 1:369 REVOLUTION DR
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145-1553
Practice Address - Country:US
Practice Address - Phone:617-864-7005
Practice Address - Fax:857-400-0712
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5302152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist