Provider Demographics
NPI:1104099555
Name:HANRAHAN, KEVIN (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:HANRAHAN
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 PINE ST
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-2252
Mailing Address - Country:US
Mailing Address - Phone:607-324-7345
Mailing Address - Fax:
Practice Address - Street 1:43 PINE ST
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-2252
Practice Address - Country:US
Practice Address - Phone:607-324-7345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005611-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician