Provider Demographics
NPI:1760654016
Name:DR. MUNEER HANNA AND ASSOCIATES PA
Entity type:Organization
Organization Name:DR. MUNEER HANNA AND ASSOCIATES PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MUNEER
Authorized Official - Middle Name:N
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:904-722-2020
Mailing Address - Street 1:1680 SOUTHSIDE BLVD STE #100
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1924
Mailing Address - Country:US
Mailing Address - Phone:904-722-2020
Mailing Address - Fax:904-720-2032
Practice Address - Street 1:1680 SOUTHSIDE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1924
Practice Address - Country:US
Practice Address - Phone:904-722-2020
Practice Address - Fax:904-720-2032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2020-01-15
Deactivation Date:2019-08-02
Deactivation Code:
Reactivation Date:2020-01-15
Provider Licenses
StateLicense IDTaxonomies
FLOPC 2712152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620072900Medicaid
FL4861110001Medicare NSC
FL620072900Medicaid