Individual
DR. MARK ALLEN HANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
127 MAIN ST, BLACK RIVER FALLS, WI 54615-1769
(715) 284-3111
Mailing address
PO BOX 220, BLACK RIVER FALLS, WI 54615-0220
(715) 284-3111
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2876-035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
19030
—
WI
05
—
38626300
—
WI
Enumeration date
12/14/2005
Last updated
06/02/2011
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