Healthcare Provider Details

I. General information

NPI: 1790577880
Provider Name (Legal Business Name): HANNA BADGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 11TH AVE
LONGVIEW WA
98632-2504
US

IV. Provider business mailing address

167 JE JOHNSON RD
KALAMA WA
98625-9574
US

V. Phone/Fax

Practice location:
  • Phone: 360-577-1500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1790577880
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: