Provider Demographics
NPI:1891757373
Name:HANNA, EVELYN B (OD)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:B
Last Name:HANNA
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 1:814 VETERANS DR
Mailing Address - Street 2:
Mailing Address - City:CARENCRO
Mailing Address - State:LA
Mailing Address - Zip Code:70520
Mailing Address - Country:US
Mailing Address - Phone:337-896-7575
Mailing Address - Fax:387-896-9971
Practice Address - Street 1:814 VETERANS DR
Practice Address - Street 2:
Practice Address - City:CARENCRO
Practice Address - State:LA
Practice Address - Zip Code:70520
Practice Address - Country:US
Practice Address - Phone:337-896-7575
Practice Address - Fax:387-896-9971
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA910074T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1328111Medicaid
LA1328111Medicaid
LA48047Medicare ID - Type Unspecified