Healthcare Provider Details

I. General information

NPI: 1417359696
Provider Name (Legal Business Name): ELIZABETH HANNIGAN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2014
Last Update Date: 09/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 MASONIC ST
NORTHAMPTON MA
01060-3026
US

IV. Provider business mailing address

86 MASONIC ST
NORTHAMPTON MA
01060-3026
US

V. Phone/Fax

Practice location:
  • Phone: 413-586-5002
  • Fax:
Mailing address:
  • Phone: 413-586-5002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number4879
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: