MEDICARE: DR. RANDAL LINN HANSON O.D.

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	OPC3118	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194945717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDAL LINN HANSON O.D.

Provider Business Mailing Address
First Line	:	711 SW 3RD CT
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-2586
Country	:	US
Telephone Number	:	239-823-2576
Fax Number	:

Provider Business Practice Location Address
First Line	:	4600 SUMMERLIN ROAD
Second Line	:	SUITE C4
City	:	FORT MYERS
State	:	FL
Zip	:	33919-3003
Country	:	US
Telephone Number	:	239-936-2121
Fax Number	:

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

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	09/15/2010

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