Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 4901002646 | MI |
NPI | 1003804667 |
---|---|
Provider Name | Dr. Rocky G Hansen |
First Address | Greenville, MI 48838-1759 |
Second Address | Greenville, MI 48838-1905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2005 |
Last Update Date | 07/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01256 | PRIORITY HEALTH (01) | MI |
943153415 | (05) | MI |
RH002646 | BLUE CROSS BLUE SHIELD (01) | MI |
T33291 | (02) | MI |