MEDICARE: THOMAS A. HANSCOM, MD A MEDICAL CORPORATION

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	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1134306996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS A. HANSCOM, MD A MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	2021 SANTA MONICA BLVD STE 720E
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-2223
Country	:	US
Telephone Number	:	310-829-3303
Fax Number	:

Provider Business Practice Location Address
First Line	:	2021 SANTA MONICA BLVD STE 720E
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-2223
Country	:	US
Telephone Number	:	310-829-3303
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MISS JENNIFER R RANDALL
Credential	:
Telephone Number	:	310-829-3303

Provider Enumeration Date	:	01/23/2008
Last Update Date	:	01/24/2008

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