Provider Demographics
NPI:1750909800
Name:MEDWIN, HANNAH RACHEL (OD)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:RACHEL
Last Name:MEDWIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092-1767
Mailing Address - Country:US
Mailing Address - Phone:716-754-2555
Mailing Address - Fax:
Practice Address - Street 1:900 CENTER ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092-1767
Practice Address - Country:US
Practice Address - Phone:716-754-2555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV009202152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist