Provider Demographics
NPI:1649415324
Name:RACHEL W HANSEN
Entity Type:Organization
Organization Name:RACHEL W HANSEN
Other - Org Name:ONEONTA OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:WILSON
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:607-433-2360
Mailing Address - Street 1:209 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-2502
Mailing Address - Country:US
Mailing Address - Phone:607-433-2360
Mailing Address - Fax:607-433-2824
Practice Address - Street 1:209 MAIN ST
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2502
Practice Address - Country:US
Practice Address - Phone:607-433-2360
Practice Address - Fax:607-433-2824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006437152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6204460001Medicare NSC