Provider Demographics
NPI:1720390784
Name:HACKER, LAUREN IVEY (OD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:IVEY
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 1:1110 COMMERCE DR STE 112
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642-7444
Mailing Address - Country:US
Mailing Address - Phone:706-453-1922
Mailing Address - Fax:706-453-1926
Practice Address - Street 1:1110 COMMERCE DR STE 112
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642-7444
Practice Address - Country:US
Practice Address - Phone:706-453-1922
Practice Address - Fax:706-453-1926
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2596152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist