Provider Demographics
NPI:1568693273
Name:HANSON, KATIE NICOLE
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:NICOLE
Last Name:HANSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:NICOLE
Other - Last Name:GELNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:58707 115TH ST
Mailing Address - Street 2:
Mailing Address - City:ROLAND
Mailing Address - State:IA
Mailing Address - Zip Code:50236-8072
Mailing Address - Country:US
Mailing Address - Phone:812-679-8082
Mailing Address - Fax:
Practice Address - Street 1:2526 LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50014-7218
Practice Address - Country:US
Practice Address - Phone:515-292-0061
Practice Address - Fax:515-292-9184
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002465152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist