Provider Demographics
NPI:1740344894
Name:HANSON, TODD JEFFREY (OD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:JEFFREY
Last Name:HANSON
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 1:2929 PENTAGON DR
Mailing Address - Street 2:
Mailing Address - City:ST ANTHONY
Mailing Address - State:MN
Mailing Address - Zip Code:55418-3208
Mailing Address - Country:US
Mailing Address - Phone:612-781-4730
Mailing Address - Fax:612-706-2337
Practice Address - Street 1:2929 PENTAGON DR
Practice Address - Street 2:
Practice Address - City:ST ANTHONY
Practice Address - State:MN
Practice Address - Zip Code:55418-3208
Practice Address - Country:US
Practice Address - Phone:612-781-4730
Practice Address - Fax:612-706-2337
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2443152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU45093Medicare UPIN