Provider Demographics
NPI:1558053272
Name:HACKLER, ANGELA DENISE (DO 60530387)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DENISE
Last Name:HACKLER
Suffix:
Gender:F
Credentials:DO 60530387
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-3608
Mailing Address - Country:US
Mailing Address - Phone:208-553-5874
Mailing Address - Fax:
Practice Address - Street 1:306 5TH ST
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-1860
Practice Address - Country:US
Practice Address - Phone:509-758-9470
Practice Address - Fax:509-758-9478
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADO60530387156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician