Provider Demographics
NPI:1093363616
Name:HACKER, BRIANNA LEIGH (OD)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:LEIGH
Last Name:HACKER
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 1:400 BALD HILL RD STE 163
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1682
Mailing Address - Country:US
Mailing Address - Phone:401-738-9866
Mailing Address - Fax:401-738-1428
Practice Address - Street 1:400 BALD HILL RD STE 163
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1682
Practice Address - Country:US
Practice Address - Phone:401-738-9866
Practice Address - Fax:401-738-1428
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTG00691152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist