Provider Demographics
NPI:1154754810
Name:HANNA, AMORETTE (OD)
Entity type:Individual
Prefix:
First Name:AMORETTE
Middle Name:
Last Name:HANNA
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 1:10150 DONERAIL WAY APT 307
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-6235
Mailing Address - Country:US
Mailing Address - Phone:919-905-2020
Mailing Address - Fax:
Practice Address - Street 1:4005 DURHAM CHAPEL HILL BLVD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2516
Practice Address - Country:US
Practice Address - Phone:919-905-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2018-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4797152W00000X
NC2351152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCG635AMedicare PIN