Provider Demographics
NPI:1679523245
Name:HASTINGS, ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:HASTINGS
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 1:1341 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2221
Mailing Address - Country:US
Mailing Address - Phone:435-753-0700
Mailing Address - Fax:435-753-3894
Practice Address - Street 1:1341 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2221
Practice Address - Country:US
Practice Address - Phone:435-753-0700
Practice Address - Fax:435-753-3894
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT113487-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT41-0985054-148Medicaid
UTT44382Medicare UPIN