Provider Demographics
NPI:1487491536
Name:MASSENGALE, HANNAH I (OD)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:MASSENGALE
Suffix:I
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 SIXTH AVE
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-3802
Mailing Address - Country:US
Mailing Address - Phone:601-798-4182
Mailing Address - Fax:
Practice Address - Street 1:908 SIXTH AVE
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-3802
Practice Address - Country:US
Practice Address - Phone:601-798-4182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1088P-Y152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist