Provider Demographics
NPI:1881719540
Name:HANSON, RENEE CHRISTINE (OD)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:CHRISTINE
Last Name:HANSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:CHRISTINE
Other - Last Name:WYCKOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3900 E MEXICO AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3941
Mailing Address - Country:US
Mailing Address - Phone:720-524-1001
Mailing Address - Fax:720-524-1121
Practice Address - Street 1:220 S 63RD ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1619
Practice Address - Country:US
Practice Address - Phone:480-641-3937
Practice Address - Fax:480-924-5094
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12467 TPL152W00000X, 152WP0200X
AZ2318152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12467TPLOtherSTATE LICENSE
CA941717034OtherEIN