Provider Demographics
NPI:1255538153
Name:HANLON, EDWARD PATRICK (OD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:PATRICK
Last Name:HANLON
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:PO BOX 554
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61051-0554
Mailing Address - Country:US
Mailing Address - Phone:815-631-7637
Mailing Address - Fax:
Practice Address - Street 1:105 S HEATON ST
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:IL
Practice Address - Zip Code:61270-2007
Practice Address - Country:US
Practice Address - Phone:815-772-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.009960152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist