Provider Demographics
NPI:1770210114
Name:CHUSTZ, HANNAH (OD)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:CHUSTZ
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 1:550 CONNELLS PARK LANE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-6539
Mailing Address - Country:US
Mailing Address - Phone:225-924-2020
Mailing Address - Fax:225-924-2089
Practice Address - Street 1:550 CONNELLS PARK LANE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6539
Practice Address - Country:US
Practice Address - Phone:225-924-2020
Practice Address - Fax:225-924-2089
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1957-903AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist