Provider Demographics
NPI:1982604591
Name:HANEY, ELEANOR SUSAN (OD)
Entity Type:Individual
Prefix:DR
First Name:ELEANOR
Middle Name:SUSAN
Last Name:HANEY
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 1:1920 S 10TH ST # 3
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-2317
Mailing Address - Country:US
Mailing Address - Phone:646-660-0891
Mailing Address - Fax:
Practice Address - Street 1:285 E PARKS HWY
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7039
Practice Address - Country:US
Practice Address - Phone:907-376-3917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3044152W00000X
CAOPT6680152W00000X
SDT482152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0001945OtherWELLMARK BCBS
SD0696610001OtherCIGNA MEDICARE
SD9202490Medicaid
SDS1945Medicare ID - Type Unspecified
SD0001945OtherWELLMARK BCBS