Individual
RYAN HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
4775 E ROCKTON RD UNIT A, ROSCOE, IL 61073-9076
(815) 242-9886
(815) 242-9809
Mailing address
4775 E ROCKTON RD UNIT A, ROSCOE, IL 61073-9076
(815) 242-9886
(815) 242-9809
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046-011291
IL
Other
Enumeration date
06/19/2017
Last updated
07/19/2021
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