Provider Demographics
NPI:1396805123
Name:HANKINSON, STEPHEN LEE (OD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:LEE
Last Name:HANKINSON
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 1:3415 ANDREWS HWY
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-5149
Mailing Address - Country:US
Mailing Address - Phone:432-689-0444
Mailing Address - Fax:432-699-0937
Practice Address - Street 1:3415 ANDREWS HWY
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-5149
Practice Address - Country:US
Practice Address - Phone:432-689-0444
Practice Address - Fax:432-699-0937
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3346TG152WS0006X, 152WC0802X, 152W00000X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112292105Medicaid
TX112292104Medicaid
TX81446QOtherBCBS
TX1396805123Medicaid
TX1528115185Medicaid
TXTXB103331Medicare UPIN
TX112292105Medicaid
TX1396805123Medicaid
TXT13671Medicare UPIN
TX112292104Medicaid
TX1396805123Medicare PIN