MEDICARE: HANSA ANONETAPIPAT LLC

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	TX7134	TX

General Provider Information

NPI Number	:	1629384813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HANSA ANONETAPIPAT LLC

Provider Business Mailing Address
First Line	:	3931 N HALL ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-3605
Country	:	US
Telephone Number	:	713-885-1902
Fax Number	:

Provider Business Practice Location Address
First Line	:	5270 S STATE HIGHWAY 360
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-8307
Country	:	US
Telephone Number	:	972-602-2010
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. HANSA ANONETAPIPAT
Credential	:	OD
Telephone Number	:	713-885-1902

Provider Enumeration Date	:	08/25/2010
Last Update Date	:	08/25/2010

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