Provider Demographics
NPI:1548603780
Name:HANSON, ROBERT LYNN JR
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LYNN
Last Name:HANSON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 GUS KAPLAN DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3355
Mailing Address - Country:US
Mailing Address - Phone:318-445-4188
Mailing Address - Fax:318-473-4407
Practice Address - Street 1:1915 GUS KAPLAN DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3355
Practice Address - Country:US
Practice Address - Phone:318-445-4188
Practice Address - Fax:318-473-4407
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician