Provider Demographics
NPI:1972713873
Name:HANSON, LOREN LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:LOREN
Middle Name:LEE
Last Name:HANSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18485 JAMBEAU CT
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-6414
Mailing Address - Country:US
Mailing Address - Phone:952-898-2137
Mailing Address - Fax:
Practice Address - Street 1:18485 JAMBEAU CT
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-6414
Practice Address - Country:US
Practice Address - Phone:952-898-2137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2306152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU05288Medicare UPIN