Provider Demographics
NPI:1225228992
Name:TODD A. HACKNEY, O.D. A PROFESSIONAL
Entity Type:Organization
Organization Name:TODD A. HACKNEY, O.D. A PROFESSIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:HACKNEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:435-259-9441
Mailing Address - Street 1:471 S MAIN ST STE 7
Mailing Address - Street 2:
Mailing Address - City:MOAB
Mailing Address - State:UT
Mailing Address - Zip Code:84532-2980
Mailing Address - Country:US
Mailing Address - Phone:435-259-9441
Mailing Address - Fax:435-259-2431
Practice Address - Street 1:471 S MAIN ST STE 7
Practice Address - Street 2:
Practice Address - City:MOAB
Practice Address - State:UT
Practice Address - Zip Code:84532-2980
Practice Address - Country:US
Practice Address - Phone:435-259-9441
Practice Address - Fax:435-259-2431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT94-2774589934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT52892887001001OtherBCBS
UT528928870004Medicaid
UT4200440001Medicare NSC