Provider Demographics
NPI:1336614148
Name:HANISH, STEFAN (OD)
Entity Type:Individual
Prefix:DR
First Name:STEFAN
Middle Name:
Last Name:HANISH
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 8115
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47716-8115
Mailing Address - Country:US
Mailing Address - Phone:812-200-8112
Mailing Address - Fax:812-200-2823
Practice Address - Street 1:6436 E. FLORIDA STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715
Practice Address - Country:US
Practice Address - Phone:812-200-8112
Practice Address - Fax:812-200-2823
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004134A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300019943Medicaid