Provider Demographics
NPI:1316670748
Name:HANNA, MYRNA SIDAROUS (OD)
Entity type:Individual
Prefix:DR
First Name:MYRNA
Middle Name:SIDAROUS
Last Name:HANNA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MYRNA
Other - Middle Name:MARY
Other - Last Name:SIDAROUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:410 W RACE AVE
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4133
Mailing Address - Country:US
Mailing Address - Phone:703-489-6599
Mailing Address - Fax:
Practice Address - Street 1:410 W RACE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4133
Practice Address - Country:US
Practice Address - Phone:501-268-3577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-04
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2846152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist