MEDICARE: DR. JENNY RANAE HAHNE O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TA1911	MD

General Provider Information

NPI Number	:	1457348559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNY RANAE HAHNE O.D.

Provider Business Mailing Address
First Line	:	200 HOSPITAL DR
Second Line	:	SUITE 600
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-5884
Country	:	US
Telephone Number	:	410-766-3937
Fax Number	:	410-761-4386

Provider Business Practice Location Address
First Line	:	200 HOSPITAL DR
Second Line	:	SUITE 600
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-5884
Country	:	US
Telephone Number	:	410-766-3937
Fax Number	:	410-761-4386

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	10/12/2007

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