Provider Demographics
NPI:1699763060
Name:HANLEN, HARVEY P (OD)
Entity type:Individual
Prefix:
First Name:HARVEY
Middle Name:P
Last Name:HANLEN
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 1:104 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOALSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16827-1347
Mailing Address - Country:US
Mailing Address - Phone:814-466-2020
Mailing Address - Fax:814-808-6165
Practice Address - Street 1:104 W. MAIN ST.
Practice Address - Street 2:
Practice Address - City:BOALSBURG
Practice Address - State:PA
Practice Address - Zip Code:16827
Practice Address - Country:US
Practice Address - Phone:814-466-2020
Practice Address - Fax:814-808-6165
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000563152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
093607Medicare ID - Type Unspecified
T28468Medicare UPIN