MEDICARE: TRICIA HANSON

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	156FX1800X	Optician

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	:	1407234545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRICIA HANSON

Provider Business Mailing Address
First Line	:	608 N 24TH ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904-2613
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	358 MAIN ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80911-1713
Country	:	US
Telephone Number	:	719-391-2000
Fax Number	:

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

Provider Enumeration Date	:	05/08/2015
Last Update Date	:	05/08/2015

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Directions to “ TRICIA HANSON ” Practice Location

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