MEDICARE: MRS. JULIE ANN HANSON 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	4901004237	MI

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	:	1326024605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIE ANN HANSON OD

Provider Business Mailing Address
First Line	:	142 W UPTON AVE
Second Line	:
City	:	REED CITY
State	:	MI
Zip	:	49677-1130
Country	:	US
Telephone Number	:	231-832-3218
Fax Number	:	231-832-3628

Provider Business Practice Location Address
First Line	:	142 W UPTON AVE
Second Line	:
City	:	REED CITY
State	:	MI
Zip	:	49677-1130
Country	:	US
Telephone Number	:	231-832-3218
Fax Number	:	231-832-3628

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

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	02/26/2013

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