Provider Demographics
NPI:1366097511
Name:HANLON, JOHN (OD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:HANLON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 KIWANIS DR
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-6921
Mailing Address - Country:US
Mailing Address - Phone:815-235-6177
Mailing Address - Fax:
Practice Address - Street 1:102 W ROCK FALLS RD
Practice Address - Street 2:
Practice Address - City:ROCK FALLS
Practice Address - State:IL
Practice Address - Zip Code:61071-2960
Practice Address - Country:US
Practice Address - Phone:815-626-7700
Practice Address - Fax:815-235-6180
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046011346152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist