Provider Demographics
NPI:1508838012
Name:HANLEY, GARY L (OD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:L
Last Name:HANLEY
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 1:64 WEST ST
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-1118
Mailing Address - Country:US
Mailing Address - Phone:518-483-7222
Mailing Address - Fax:518-483-7288
Practice Address - Street 1:64 WEST ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1118
Practice Address - Country:US
Practice Address - Phone:518-483-7222
Practice Address - Fax:518-483-7288
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003649-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00603883Medicaid
NYT-26374Medicare UPIN
NYGH32393BMedicare ID - Type Unspecified