=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962670737
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STANLEY D. HANSON O.D. PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2008
-----------------------------------------------------
Last Update Date | 05/19/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 850 E HARVARD AVE SUITE 205
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80210-5073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-777-8551
-----------------------------------------------------
Fax | 303-777-8435
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 850 E HARVARD AVE SUITE 205
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80210-5073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-777-8551
-----------------------------------------------------
Fax | 303-777-8435
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. STANLEY DEAN HANSON
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 303-777-8551
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 899
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------