Provider Demographics
NPI:1356379929
Name:JOHN CHRISTOPHER HANFORD OD INC
Entity type:Organization
Organization Name:JOHN CHRISTOPHER HANFORD OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:HANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:231-933-7195
Mailing Address - Street 1:5226 S SHOREVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:SUTTONS BAY
Mailing Address - State:MI
Mailing Address - Zip Code:49682-9164
Mailing Address - Country:US
Mailing Address - Phone:231-933-7195
Mailing Address - Fax:231-933-7197
Practice Address - Street 1:2640 CROSSING CIR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7930
Practice Address - Country:US
Practice Address - Phone:231-933-7195
Practice Address - Fax:231-933-7197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003271152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P32870Medicare PIN