Provider Demographics
NPI:1386621704
Name:HANEY, RICHARD P (OD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:P
Last Name:HANEY
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 1:3772 43RD AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-1681
Mailing Address - Country:US
Mailing Address - Phone:402-563-3686
Mailing Address - Fax:402-564-1797
Practice Address - Street 1:3772 43RD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-1681
Practice Address - Country:US
Practice Address - Phone:402-563-3686
Practice Address - Fax:402-564-1797
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE898152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE36750OtherBLUE CROSS BLUE SHIELD
NE47082635804Medicaid
NE272345Medicare ID - Type Unspecified
NE36750OtherBLUE CROSS BLUE SHIELD