Provider Demographics
NPI:1982873279
Name:MICHAEL A HATTAN OD
Entity Type:Organization
Organization Name:MICHAEL A HATTAN OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-625-2226
Mailing Address - Street 1:PO BOX 357
Mailing Address - Street 2:1517 E 27TH ST
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-0357
Mailing Address - Country:US
Mailing Address - Phone:785-625-2226
Mailing Address - Fax:
Practice Address - Street 1:1517 E 27TH ST
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2111
Practice Address - Country:US
Practice Address - Phone:785-625-2226
Practice Address - Fax:785-625-9167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
KS11693332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS005158OtherBLUE CROSS BLUE SHIELD
KS30004683530001Medicaid