MEDICARE: RICHARD P HANEY 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	898	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	36750	OTHER	NE	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386621704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD P HANEY O.D.

Provider Business Mailing Address
First Line	:	3772 43RD AVE
Second Line	:	SUITE A
City	:	COLUMBUS
State	:	NE
Zip	:	68601-1681
Country	:	US
Telephone Number	:	402-563-3686
Fax Number	:	402-564-1797

Provider Business Practice Location Address
First Line	:	3772 43RD AVE
Second Line	:	SUITE A
City	:	COLUMBUS
State	:	NE
Zip	:	68601-1681
Country	:	US
Telephone Number	:	402-563-3686
Fax Number	:	402-564-1797

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

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	01/17/2008

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