MEDICARE: STACEY MARIE HANNAN 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	OEG001285	PA
2	152WC0802X	Corneal and Contact Management Optometrist	OEG001285	PA
3	152WX0102X	Occupational Vision Optometrist	OEG001285	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1594678	OTHER	PA	HIGHMARK BC/BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699711747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY MARIE HANNAN O.D.

Provider Business Mailing Address
First Line	:	8131 POST RD
Second Line	:
City	:	ALLISON PARK
State	:	PA
Zip	:	15101-3334
Country	:	US
Telephone Number	:	724-612-3943
Fax Number	:

Provider Business Practice Location Address
First Line	:	2010 VILLAGE CENTER DR
Second Line	:	WAL-MART VISION CENTER
City	:	TARENTUM
State	:	PA
Zip	:	15084-3844
Country	:	US
Telephone Number	:	724-274-0276
Fax Number	:

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

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	12/20/2007

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