Hanson, Mark Allen
Hanson, Mark Allen is an individual health care provider with primary practice located at 127 Main St , Black River Falls WI 54615-1769. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Hanson, Mark Allen can be contacted via phone (715) 284-3111.Contact Information
Primary practice address
127 Main St
Black River Falls WI 54615-1769
Phone: (715) 284-3111
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 2876-035 | Wisconsin |
Profile Details
| NPI number | 1255316956 |
|---|---|
| LBN Legal business name | Hanson, Mark Allen |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 14th, 2005 |
| Last updated | Jun 2nd, 2011 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1255316956 | NPPES |
| Wisconsin | MEDICAID | 19030 | |
| Wisconsin | MEDICAID | 38626300 |
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