Provider Demographics
NPI:1629384813
Name:HANSA ANONETAPIPAT LLC
Entity Type:Organization
Organization Name:HANSA ANONETAPIPAT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HANSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANONETAPIPAT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:713-885-1902
Mailing Address - Street 1:3931 N HALL ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-3605
Mailing Address - Country:US
Mailing Address - Phone:713-885-1902
Mailing Address - Fax:
Practice Address - Street 1:5270 S STATE HIGHWAY 360
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-8307
Practice Address - Country:US
Practice Address - Phone:972-602-2010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX7134152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty