Healthcare Provider Details

I. General information

NPI: 1609854850
Provider Name (Legal Business Name): ROBERT J HANAK O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3923 WASHINGTON RD
MC MURRAY PA
15317-2532
US

IV. Provider business mailing address

2212 SHAWNEE DR
WASHINGTON PA
15301-2139
US

V. Phone/Fax

Practice location:
  • Phone: 412-941-5100
  • Fax:
Mailing address:
  • Phone: 412-537-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000597
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: