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Individual

DR. BRADY P. HANLON

Active
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Individual

DR. BRADY P. HANLON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
O.D.

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18003296A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000368674
ANTHEM BCBS
IN
01
—
003
DAVIS VISION
IN
01
—
0356760001
DMERC
IN
01
—
200517920
MOLINA
IN
05
—
200517920
—
IN
Enumeration date
10/05/2005
Last updated
10/11/2012
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