Provider Demographics
NPI:1932113511
Name:HAKE, TARA RANEY (OD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:RANEY
Last Name:HAKE
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 1:1331 POYNTZ AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-4362
Mailing Address - Country:US
Mailing Address - Phone:785-537-2420
Mailing Address - Fax:785-537-4980
Practice Address - Street 1:1331 POYNTZ AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-4362
Practice Address - Country:US
Practice Address - Phone:785-537-2420
Practice Address - Fax:785-537-4980
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1745152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200420280AMedicaid
KS1932113511Medicare NSC
KSV10207Medicare UPIN