Provider Demographics
NPI:1679540892
Name:HANSON, GEORGE A (OD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:A
Last Name:HANSON
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 1:7815 W BURLEIGH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-4914
Mailing Address - Country:US
Mailing Address - Phone:414-873-5135
Mailing Address - Fax:414-873-8808
Practice Address - Street 1:7815 W BURLEIGH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-4914
Practice Address - Country:US
Practice Address - Phone:414-873-5135
Practice Address - Fax:414-873-8808
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1731152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38525500Medicaid
WIT62123Medicare UPIN
WI0575630001Medicare NSC
WI410010034Medicare PIN