Provider Demographics
NPI:1134829732
Name:SPIEGEL, HANNAH TEAR (OD)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:TEAR
Last Name:SPIEGEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:TEAR
Other - Last Name:GAUDETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:100 OAK ST
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-5134
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:636-527-0766
Practice Address - Street 1:100 OAK ST
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-5134
Practice Address - Country:US
Practice Address - Phone:734-284-2444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-03
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI4901005675152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program