Provider Demographics
NPI:1104267103
Name:HANSON, TYLER A (OD)
Entity type:Individual
Prefix:
First Name:TYLER
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 1:420 N DIERS AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4979
Mailing Address - Country:US
Mailing Address - Phone:308-384-0220
Mailing Address - Fax:308-382-1650
Practice Address - Street 1:420 N DIERS AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4979
Practice Address - Country:US
Practice Address - Phone:308-384-0220
Practice Address - Fax:308-382-1650
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1393152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01290223OtherRAILROAD MEDICARE
NE092174002Medicare PIN
NA1624002Medicare PIN
0290380004Medicare NSC
0290380001Medicare NSC