Individual
COLLEEN HANNEGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDO
Contact information
Practice address
21098 BAKE PKWY, SUITE 110, LAKE FOREST, CA 92630-2163
(949) 597-0104
(949) 597-0106
Mailing address
21098 BAKE PKWY, SUITE 110, LAKE FOREST, CA 92630-2163
(949) 597-0104
(949) 597-0106
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
SL 1762
CA
Other
Enumeration date
01/04/2007
Last updated
09/22/2009
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