Individual
DOUGLAS P HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
9598 MICKELBERRY RD NW, SILVERDALE, WA 98383-8339
(360) 698-5062
(360) 698-5231
Mailing address
PO BOX 1506, CHEHALIS, WA 98532-0409
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD00002055
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1021102
—
WA
05
—
123328
—
OR
01
—
410021676
RAIL ROAD MEDICARE
WA
01
—
410043367
RAIL ROAD MEDICARE
WA
01
—
410045029
RAIL ROAD MEDICARE
OR
01
—
410045030
RAIL ROAD MEDICARE
WA
Enumeration date
08/24/2006
Last updated
11/23/2020
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