Provider Demographics
NPI:1740036599
Name:HANCOCK, ANITA (LDO,ABOC,NCLEC)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:LDO,ABOC,NCLEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31768-7621
Mailing Address - Country:US
Mailing Address - Phone:229-891-1255
Mailing Address - Fax:229-985-3193
Practice Address - Street 1:641 VETERANS PKWY S
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31788-8843
Practice Address - Country:US
Practice Address - Phone:229-890-7416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO002678156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician