Provider Demographics
NPI:1285656553
Name:HANNA, MUNEER NABEEL (OD)
Entity type:Individual
Prefix:DR
First Name:MUNEER
Middle Name:NABEEL
Last Name:HANNA
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 1:1680 SOUTHSIDE BLVD # 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 # 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5712152W00000X
FLOPC2712152W00000X
FL2712152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620072900Medicaid
FL620072900Medicaid
FL20568Medicare PIN
FL4861110001Medicare PIN