Individual
DR. KENNETH RICHARD HANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
311 N ANKENY BLVD, ANKENY, IA 50023-1711
(515) 964-1671
(515) 964-1714
Mailing address
311 N ANKENY BLVD, ANKENY, IA 50023-1711
(515) 964-1671
(515) 964-1714
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
01592
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1142968
—
IA
01
—
1306056510
NPI TYPE II
IA
01
—
14296
BLUE CROSS BLUE SHIELD
IA
01
—
204163573
TAX ID
IA
01
—
5648350001
DMERC
IA
01
—
DE6338
RAIL ROAD MEDICARE
IA
Enumeration date
06/17/2005
Last updated
02/05/2013
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