Individual
DR. THEODORE LESTER HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
115 EAST LAKE ST, MINNEAPOLIS, MN 55408
(612) 827-3857
(612) 827-7204
Mailing address
115 EAST LAKE ST, MINNEAPOLIS, MN 55408
(612) 827-3857
(612) 827-7204
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2086
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102434
UCARE
MN
01
—
2213318
MEDICA
MN
01
—
85750HA
BLUE CROSS BLUE SHIELD
MN
01
—
922371040939
PREFERRED ONE
MN
Enumeration date
09/25/2006
Last updated
07/08/2007
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