Individual
JACOB HANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2814 KENT AVE, CODY, WY 82414-8250
(307) 272-2716
Mailing address
1624 NC HIGHWAY 14, APT A-2, REIDSVILLE, NC 27320-9666
(307) 272-6875
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618002148
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/21/2012
Last updated
03/30/2016
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