Provider Demographics
NPI:1518052091
Name:HAGEN, BRETT NORMAN (OD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:NORMAN
Last Name:HAGEN
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 1:521 W. GARLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-2954
Mailing Address - Country:US
Mailing Address - Phone:509-327-9505
Mailing Address - Fax:509-325-3277
Practice Address - Street 1:521 W. GARLAND AVENUE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-2954
Practice Address - Country:US
Practice Address - Phone:509-327-9505
Practice Address - Fax:509-325-3277
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3101TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2024560Medicaid
WAE08254OtherKCMB SHIELD
WA0145801OtherL & I
WA4008190001OtherDMERC
WAE08254OtherKCMB SHIELD
WA4008190001OtherDMERC