Provider Demographics
NPI:1528017050
Name:HASSELL, MIKE (OD)
Entity Type:Individual
Prefix:
First Name:MIKE
Middle Name:
Last Name:HASSELL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:R
Other - Last Name:HASSELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 116
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37030-0116
Mailing Address - Country:US
Mailing Address - Phone:615-735-2020
Mailing Address - Fax:615-735-9098
Practice Address - Street 1:605 MAIN ST N
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TN
Practice Address - Zip Code:37030-1211
Practice Address - Country:US
Practice Address - Phone:615-735-2020
Practice Address - Fax:615-735-9098
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD0000000889152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3595240Medicaid
TN0040299OtherBLUE CROSS BLUE SHIELD
TN0040299OtherBLUE CROSS BLUE SHIELD
TNT61235Medicare UPIN