Provider Demographics
NPI:1891978797
Name:MARK R HANSON OD PA
Entity Type:Organization
Organization Name:MARK R HANSON OD PA
Other - Org Name:INSIGHT VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD, PA
Authorized Official - Phone:817-861-2020
Mailing Address - Street 1:2351 W LAMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012
Mailing Address - Country:US
Mailing Address - Phone:817-861-2020
Mailing Address - Fax:817-274-0747
Practice Address - Street 1:2351 W LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012
Practice Address - Country:US
Practice Address - Phone:817-861-2020
Practice Address - Fax:817-274-0747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3043TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5332290001OtherDMERC
TX5332290001OtherDMERC
TX00369YMedicare PIN