MEDICARE: KENNETH DAVID HANSEN 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	OPC 1542	FL

General Provider Information

NPI Number	:	1316159940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH DAVID HANSEN O.D.

Provider Business Mailing Address
First Line	:	3705 SE 48TH ST
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34480-7385
Country	:	US
Telephone Number	:	352-622-3711
Fax Number	:

Provider Business Practice Location Address
First Line	:	15936 E HIGHWAY 40
Second Line	:
City	:	SILVER SPRINGS
State	:	FL
Zip	:	34488-5144
Country	:	US
Telephone Number	:	352-625-0135
Fax Number	:

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

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	07/08/2007

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