Provider Demographics
NPI:1285957233
Name:DR HANSON & ASSOCIATES PA
Entity type:Organization
Organization Name:DR HANSON & ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDAL
Authorized Official - Middle Name:LINN
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:239-936-2121
Mailing Address - Street 1:4600 SUMMERLIN RD STE C4
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3003
Mailing Address - Country:US
Mailing Address - Phone:239-936-2121
Mailing Address - Fax:
Practice Address - Street 1:4600 SUMMERLIN RD STE C4
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3003
Practice Address - Country:US
Practice Address - Phone:239-936-2121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-04
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3118152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU69491Medicare UPIN
FL20792CMedicare PIN