MEDICARE: DR. ROCKY G HANSEN OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4901002646	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RH002646	OTHER	MI	BLUE CROSS BLUE SHIELD
2	01256	OTHER	MI	PRIORITY HEALTH
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003804667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROCKY G HANSEN OD

Provider Business Mailing Address
First Line	:	307 S FRANKLIN ST
Second Line	:
City	:	GREENVILLE
State	:	MI
Zip	:	48838-1759
Country	:	US
Telephone Number	:	616-754-7143
Fax Number	:	616-754-2778

Provider Business Practice Location Address
First Line	:	307 S FRANKLIN
Second Line	:
City	:	GREENVILLE
State	:	MI
Zip	:	48838-1905
Country	:	US
Telephone Number	:	616-754-7143
Fax Number	:	616-754-2778

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	02/07/2020

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