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General NPI Number Information
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NPI Number | 1013206580
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Entity Type | Organization
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Legal Business Name | CRAIG T. HANLEY, O.D., P.A.
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Dates
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Enumeration Date | 04/05/2011
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Last Update Date | 04/05/2011
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Provider Practice Location Address
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Address Line | 715 17 ST.
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City | VERO BEACH
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State | FL
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Zip | 32960
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Country | US
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Telephone | 772-933-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 656 S. EASY STREET
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City | SEBASTIAN
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State | FL
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Zip | 32958
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Country | US
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Telephone | 954-691-7160
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Fax | 954-763-2850
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Authorized Official
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Title or Position | PRESIDENT
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Name | CRAIG T. HANLEY
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Credential | O.D.
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Telephone | 954-691-7160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC-1651
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License Number State | FL
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