Individual
STACEY MARIE HANNAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG001285
PA
152WC0802X
Corneal and Contact Management Optometrist
OEG001285
PA
152WX0102X
Occupational Vision Optometrist
OEG001285
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1009498450001
—
PA
01
—
1594678
HIGHMARK BC/BS
PA
Enumeration date
06/20/2006
Last updated
12/20/2007
Update your record
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