Provider Demographics
NPI:1760436042
Name:HANFORD, JOHN CHRISTOPHER (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHRISTOPHER
Last Name:HANFORD
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 1:5226 S SHOREVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:SUTTONS BAY
Mailing Address - State:MI
Mailing Address - Zip Code:49682-9164
Mailing Address - Country:US
Mailing Address - Phone:231-933-7195
Mailing Address - Fax:231-933-7197
Practice Address - Street 1:2640 CROSSING CIR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7930
Practice Address - Country:US
Practice Address - Phone:231-933-7195
Practice Address - Fax:231-933-7197
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003271152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT86672Medicare UPIN
MI0B86519Medicare ID - Type Unspecified