Provider Demographics
NPI:1548391790
Name:EVELYN B HANNA OD A PROFESSIONAL OPTOMETRY CORP
Entity Type:Organization
Organization Name:EVELYN B HANNA OD A PROFESSIONAL OPTOMETRY CORP
Other - Org Name:CARENCRO EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:B
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:337-896-7575
Mailing Address - Street 1:814 VETERANS DR
Mailing Address - Street 2:
Mailing Address - City:CARENCRO
Mailing Address - State:LA
Mailing Address - Zip Code:70520-3701
Mailing Address - Country:US
Mailing Address - Phone:337-896-7575
Mailing Address - Fax:
Practice Address - Street 1:814 VETERANS DR
Practice Address - Street 2:
Practice Address - City:CARENCRO
Practice Address - State:LA
Practice Address - Zip Code:70520-3701
Practice Address - Country:US
Practice Address - Phone:337-896-7575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA910074T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1328111Medicaid
LAT19495Medicare UPIN
LA48047Medicare PIN
LA0586860001Medicare NSC