Provider Demographics
NPI:1487723185
Name:HANCOCK, EVELYN KAY
Entity type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:KAY
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 E SAN ANTONIO ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-4137
Mailing Address - Country:US
Mailing Address - Phone:830-997-4800
Mailing Address - Fax:830-990-1427
Practice Address - Street 1:207 E SAN ANTONIO ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4137
Practice Address - Country:US
Practice Address - Phone:830-997-4800
Practice Address - Fax:830-990-1427
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1322010001Medicare ID - Type UnspecifiedPROVIDER NUMBER