Provider Demographics
NPI:1689233447
Name:HANSEN, KATELYN LANE (OD)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:LANE
Last Name:HANSEN
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 1:8300 OAK DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:MN
Mailing Address - Zip Code:55386-8230
Mailing Address - Country:US
Mailing Address - Phone:605-695-2084
Mailing Address - Fax:
Practice Address - Street 1:600 MARKET ST STE 190
Practice Address - Street 2:
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-4572
Practice Address - Country:US
Practice Address - Phone:952-937-9465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3615152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist