Provider Demographics
NPI:1265598841
Name:HANUS, STACI M (OD)
Entity type:Individual
Prefix:DR
First Name:STACI
Middle Name:M
Last Name:HANUS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:11606 NICHOLAS ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-4478
Mailing Address - Country:US
Mailing Address - Phone:402-493-2020
Mailing Address - Fax:402-493-8341
Practice Address - Street 1:1500 S 48TH ST
Practice Address - Street 2:SUITE 610
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1276
Practice Address - Country:US
Practice Address - Phone:402-483-4448
Practice Address - Fax:402-483-4750
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE1221152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEP00160845OtherRR MEDICARE
NE281572OtherMEDICARE
NE06945OtherBLUE CROSS
NEP00200037OtherRR MEDICARE
V00898Medicare UPIN
NEP00160845OtherRR MEDICARE
NE06945OtherBLUE CROSS