Provider Demographics
NPI:1619756665
Name:MASSA, HANNAH (OD)
Entity Type:Individual
Prefix:DR
First Name:HANNAH
Middle Name:
Last Name:MASSA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4325 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1216
Mailing Address - Country:US
Mailing Address - Phone:810-394-6926
Mailing Address - Fax:
Practice Address - Street 1:1449 BOARDMAN CANFIELD RD STE 230
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-8053
Practice Address - Country:US
Practice Address - Phone:330-758-6671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.007221152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist