Provider Demographics
NPI:1740298041
Name:HANSEN, ALISON D (OD)
Entity type:Individual
Prefix:DR
First Name:ALISON
Middle Name:D
Last Name:HANSEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4606 E 67TH ST
Mailing Address - Street 2:#400
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-4943
Mailing Address - Country:US
Mailing Address - Phone:918-481-2796
Mailing Address - Fax:918-481-2785
Practice Address - Street 1:4606 E 67TH ST
Practice Address - Street 2:#400
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-4943
Practice Address - Country:US
Practice Address - Phone:918-481-2796
Practice Address - Fax:918-481-2785
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2362152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100735860AOtherMEDICAID GROUP
OK800522449OtherMEDICARE GROUP #
OK1447244827OtherNPI GROUP
OK200002500BMedicaid
OK1447244827OtherNPI GROUP
OK100735860AOtherMEDICAID GROUP