MEDICARE: DR. ALICIA D. HANNA 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	894-D	WV

General Provider Information

NPI Number	:	1669584751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALICIA D. HANNA O.D.

Provider Business Mailing Address
First Line	:	15 GREENTREE DR
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26508-8635
Country	:	US
Telephone Number	:	304-594-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	5005 GREENBAG RD
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26501-7124
Country	:	US
Telephone Number	:	304-292-4896
Fax Number	:

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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