Provider Demographics
NPI:1427044387
Name:HACKLEMAN, JEFFREY SCOT (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:SCOT
Last Name:HACKLEMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 SOUTHWIND DR
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:GA
Mailing Address - Zip Code:30621-1366
Mailing Address - Country:US
Mailing Address - Phone:706-705-1055
Mailing Address - Fax:
Practice Address - Street 1:2427 HERITAGE VLG STE 4
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2699
Practice Address - Country:US
Practice Address - Phone:770-978-2020
Practice Address - Fax:770-978-1750
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1935152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU86197Medicare UPIN