Provider Demographics
NPI:1295570976
Name:MILLETT, HANSEN THOMAS (OD)
Entity type:Individual
Prefix:DR
First Name:HANSEN
Middle Name:THOMAS
Last Name:MILLETT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3713 AV DE PARIS DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63034-3107
Mailing Address - Country:US
Mailing Address - Phone:425-445-7454
Mailing Address - Fax:
Practice Address - Street 1:7840 NATURAL BRIDGE RD # PCC
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-4617
Practice Address - Country:US
Practice Address - Phone:314-516-5131
Practice Address - Fax:314-516-5507
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024022113152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist