Healthcare Provider Details

I. General information

NPI: 1245922517
Provider Name (Legal Business Name): DAVID MARK HANS SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 HARBOURTOWN BLVD
LITTLE EGG HARBOR TWP NJ
08087-3314
US

IV. Provider business mailing address

342 HARBOURTOWN BLVD
LITTLE EGG HARBOR TWP NJ
08087-3314
US

V. Phone/Fax

Practice location:
  • Phone: 856-264-6165
  • Fax: 609-296-7929
Mailing address:
  • Phone: 856-264-6165
  • Fax: 609-296-7929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number31TD00397900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: