Provider Demographics
NPI:1629760731
Name:HANSEN EYECARE LLC
Entity Type:Organization
Organization Name:HANSEN EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:253-341-5091
Mailing Address - Street 1:7831 EAGLE ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-1148
Mailing Address - Country:US
Mailing Address - Phone:253-341-5091
Mailing Address - Fax:630-206-2815
Practice Address - Street 1:7831 EAGLE ST
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-1148
Practice Address - Country:US
Practice Address - Phone:253-341-5091
Practice Address - Fax:630-206-2815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty