Provider Demographics
NPI:1982756698
Name:HANSEN, LAURA A (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:HANSEN
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 PINECREST RD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863-8432
Mailing Address - Country:US
Mailing Address - Phone:719-686-9343
Mailing Address - Fax:719-686-9342
Practice Address - Street 1:755 GOLD HILL PL
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863
Practice Address - Country:US
Practice Address - Phone:719-686-9343
Practice Address - Fax:719-686-9342
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
COOP1542OtherEYEMED INSURANCE