Provider Demographics
NPI:1821271552
Name:HANISH EYE INSTITUTE P.C.
Entity Type:Organization
Organization Name:HANISH EYE INSTITUTE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HANISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-731-5656
Mailing Address - Street 1:1A VILLAGE SQUARE SHOP CTR
Mailing Address - Street 2:
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-1817
Mailing Address - Country:US
Mailing Address - Phone:314-731-5656
Mailing Address - Fax:314-731-3215
Practice Address - Street 1:1A VILLAGE SQUARE SHOP CTR
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-1817
Practice Address - Country:US
Practice Address - Phone:314-731-5656
Practice Address - Fax:314-731-3215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8613207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO16711OtherMOBCBS
MO0800058OtherUHC
IL989200Medicare PIN