Provider Demographics
NPI:1679855464
Name:HASNAIN, MADINA (OD)
Entity Type:Individual
Prefix:
First Name:MADINA
Middle Name:
Last Name:HASNAIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22312 W THURMAN AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-2536
Mailing Address - Country:US
Mailing Address - Phone:951-454-0460
Mailing Address - Fax:
Practice Address - Street 1:22312 W THURMAN AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-2536
Practice Address - Country:US
Practice Address - Phone:951-454-0460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14032152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist