Provider Demographics
NPI:1194989996
Name:HANNA, EISSA (MD)
Entity type:Individual
Prefix:
First Name:EISSA
Middle Name:
Last Name:HANNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 N TOWN CENTER DR STE 212
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-0516
Mailing Address - Country:US
Mailing Address - Phone:702-982-1360
Mailing Address - Fax:702-202-3489
Practice Address - Street 1:653 N TOWN CENTER DR STE 212
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-0516
Practice Address - Country:US
Practice Address - Phone:702-982-1360
Practice Address - Fax:702-202-3489
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60284655207W00000X
NV20619207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1194989996Medicaid
WA1194989996Medicaid
WA1194989996Medicaid