Provider Demographics
NPI:1639128861
Name:HATTAN, MICHAEL ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALAN
Last Name:HATTAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 E 27TH ST
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2111
Mailing Address - Country:US
Mailing Address - Phone:785-625-2226
Mailing Address - Fax:785-625-9167
Practice Address - Street 1:1517 E 27TH ST
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2111
Practice Address - Country:US
Practice Address - Phone:785-625-2226
Practice Address - Fax:785-625-9167
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1169-3152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30004371840002Medicaid
KS5158OtherBLUE CROSS BLUE SHIELD KS
KS005158Medicare ID - Type Unspecified
KST43679Medicare UPIN