Provider Demographics
NPI:1871510511
Name:HANLEY, CRAIG T (OD, PA)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:T
Last Name:HANLEY
Suffix:
Gender:M
Credentials:OD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1489 SE 17TH ST
Mailing Address - Street 2:SUITE 2J
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-1734
Mailing Address - Country:US
Mailing Address - Phone:954-763-2842
Mailing Address - Fax:954-763-2850
Practice Address - Street 1:1489 SE 17TH ST
Practice Address - Street 2:SUITE 2J
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1734
Practice Address - Country:US
Practice Address - Phone:954-763-2842
Practice Address - Fax:954-763-2850
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC-1651152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL57-1174449OtherTAX ID
FLOP-1651OtherLICENSE NUMBER
FLOP-1651OtherLICENSE NUMBER