Provider Demographics
NPI:1902963150
Name:IRA J. HANLON, O.D.P.A.
Entity Type:Organization
Organization Name:IRA J. HANLON, O.D.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HANLON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:732-613-1500
Mailing Address - Street 1:434 HIGHWAY 18
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-2374
Mailing Address - Country:US
Mailing Address - Phone:732-613-1500
Mailing Address - Fax:732-238-4357
Practice Address - Street 1:434 HIGHWAY 18
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-2374
Practice Address - Country:US
Practice Address - Phone:732-613-1500
Practice Address - Fax:732-238-4357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00433900152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ452963Medicare PIN
NJU01546Medicare UPIN