MEDICARE: CRAIG T HANLEY O.D., P.A.

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	OPC-1651	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	57-1174449	OTHER	FL	TAX ID
2	OP-1651	OTHER	FL	LICENSE NUMBER

General Provider Information

NPI Number	:	1871510511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG T HANLEY O.D., P.A.

Provider Business Mailing Address
First Line	:	1489 SE 17TH ST
Second Line	:	SUITE 2J
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33316-1734
Country	:	US
Telephone Number	:	954-763-2842
Fax Number	:	954-763-2850

Provider Business Practice Location Address
First Line	:	1489 SE 17TH ST
Second Line	:	SUITE 2J
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33316-1734
Country	:	US
Telephone Number	:	954-763-2842
Fax Number	:	954-763-2850

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	04/05/2011

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