Provider Demographics
NPI:1730264904
Name:HANSON, DENISE M (OD)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:M
Last Name:HANSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 N BAIRD AVE
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-1617
Mailing Address - Country:US
Mailing Address - Phone:218-736-5609
Mailing Address - Fax:218-736-5600
Practice Address - Street 1:810 N BAIRD AVE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-1617
Practice Address - Country:US
Practice Address - Phone:218-736-5609
Practice Address - Fax:218-736-5600
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLD2736000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN670938900Medicaid
MN282T0HAOtherBCBS
ND60535Medicaid
MN1021893OtherPREFERRED ONE
NDHAN892736OtherND VISION SERVICE
MN2201477OtherMEDICA
MN282T0HAOtherBCBS
ND60535Medicaid
MN282T0HAOtherBCBS
MN4730630001Medicare NSC