Provider Demographics
NPI:1891723508
Name:HANLEY, MICHELE LAGO (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:LAGO
Last Name:HANLEY
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 1:511 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-3404
Mailing Address - Country:US
Mailing Address - Phone:724-863-3116
Mailing Address - Fax:724-863-2489
Practice Address - Street 1:511 MAIN ST
Practice Address - Street 2:
Practice Address - City:IRWIN
Practice Address - State:PA
Practice Address - Zip Code:15642-3404
Practice Address - Country:US
Practice Address - Phone:724-863-3116
Practice Address - Fax:724-863-2489
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG 000394152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001672482-002Medicaid
PAU54189Medicare UPIN