MEDICARE: DR. JOEL HANSEN 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	3556-35	WI

General Provider Information

NPI Number	:	1598324154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOEL HANSEN OD

Provider Business Mailing Address
First Line	:	7300 W GREENFIELD AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53214-4729
Country	:	US
Telephone Number	:	414-453-6667
Fax Number	:

Provider Business Practice Location Address
First Line	:	7300 W GREENFIELD AVE
Second Line	:
City	:	WEST ALLIS
State	:	WI
Zip	:	53214-4729
Country	:	US
Telephone Number	:	414-453-6667
Fax Number	:

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

Provider Enumeration Date	:	06/07/2019
Last Update Date	:	06/07/2019

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