Provider Demographics
NPI:1427439751
Name:HANSEN FAMILY EYECARE LLC
Entity type:Organization
Organization Name:HANSEN FAMILY EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:HANSEN
Authorized Official - Last Name:PIKO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:262-597-1040
Mailing Address - Street 1:7707 94TH AVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANT PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53158-1955
Mailing Address - Country:US
Mailing Address - Phone:262-597-1040
Mailing Address - Fax:262-597-1041
Practice Address - Street 1:7707 94TH AVE
Practice Address - Street 2:
Practice Address - City:PLEASANT PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53158-1955
Practice Address - Country:US
Practice Address - Phone:262-597-1040
Practice Address - Fax:262-597-1041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3369-35261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service