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Organization
MICHAEL W HANSEN OD INC
Active
Organization
MICHAEL W HANSEN OD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL HANSEN OD (OWNER)
(310) 321-6990
Entity
Organization
Contact information
Practice address
310 AVENUE I, REDONDO BEACH, CA 90277-5601
(310) 373-3191
Mailing address
2101 ROSECRANS AVE, STE 1215, EL SEGUNDO, CA 90245-4749
(310) 321-6990
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT11354TPL
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OPT11354TPL
LICENSE
CA
Enumeration date
01/21/2014
Last updated
01/22/2014
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