Provider Demographics
NPI:1689816290
Name:HAKANSON, MATTHEW G (OD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:G
Last Name:HAKANSON
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 1:1521 38TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-6711
Mailing Address - Country:US
Mailing Address - Phone:916-832-9375
Mailing Address - Fax:
Practice Address - Street 1:1521 38TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-6711
Practice Address - Country:US
Practice Address - Phone:916-832-9375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13442152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist