Provider Demographics
NPI:1730150020
Name:HANSON, MARK A (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:HANSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:IA
Mailing Address - Zip Code:50220-1510
Mailing Address - Country:US
Mailing Address - Phone:515-465-3556
Mailing Address - Fax:
Practice Address - Street 1:1326 2ND ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:IA
Practice Address - Zip Code:50220-1510
Practice Address - Country:US
Practice Address - Phone:515-465-3556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1685T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2158097Medicaid
IA4158097Medicaid
IA1158097Medicaid
IA3158097Medicaid
IA2158097Medicaid
27923Medicare PIN
410029166Medicare PIN
T00941Medicare UPIN
IA4158097Medicaid
IA19284Medicare ID - Type Unspecified
IA3158097Medicaid
P00266729Medicare PIN
410016292Medicare PIN
09212Medicare PIN
410020243Medicare PIN
410029167Medicare PIN