Hanson, Mark Allen

Hanson, Mark Allen is an individual health care provider with primary practice located at 127 Main St , Black River Falls WI 54615-1769. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Hanson, Mark Allen can be contacted via phone (715) 284-3111.

Contact Information

Primary practice address
127 Main St Black River Falls WI 54615-1769
Phone: (715) 284-3111
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 2876-035 Wisconsin

Profile Details

NPI number 1255316956
LBN Legal business name Hanson, Mark Allen
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 14th, 2005
Last updated Jun 2nd, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1255316956 NPPES
Wisconsin MEDICAID 19030
Wisconsin MEDICAID 38626300

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