Provider Demographics
NPI:1023318227
Name:HANLON, HEATHER ANNE (OD)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:ANNE
Last Name:HANLON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:11110 MALL CIR
Mailing Address - Street 2:BOX 6140
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4803
Mailing Address - Country:US
Mailing Address - Phone:301-705-8450
Mailing Address - Fax:301-705-8448
Practice Address - Street 1:11110 MALL CIR
Practice Address - Street 2:BOX 6140
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4803
Practice Address - Country:US
Practice Address - Phone:301-705-8450
Practice Address - Fax:301-705-8448
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-22
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4588152W00000X
MDTA2223152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist