Provider Demographics
NPI: | 1760791396 |
---|---|
Name: | JAMES A HACKELY OD, LLC |
Entity Type: | Organization |
Organization Name: | JAMES A HACKELY OD, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OPTOMETRIST |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | JAMES |
Authorized Official - Middle Name: | AARON |
Authorized Official - Last Name: | HACKLEY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | OD |
Authorized Official - Phone: | 614-847-3912 |
Mailing Address - Street 1: | 1150 POLARIS PKWY |
Mailing Address - Street 2: | |
Mailing Address - City: | COLUMBUS |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 43240-2024 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 614-847-3912 |
Mailing Address - Fax: | 614-847-4138 |
Practice Address - Street 1: | 1150 POLARIS PKWY |
Practice Address - Street 2: | |
Practice Address - City: | COLUMBUS |
Practice Address - State: | OH |
Practice Address - Zip Code: | 43240-2024 |
Practice Address - Country: | US |
Practice Address - Phone: | 614-847-3912 |
Practice Address - Fax: | 614-847-4138 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-09-30 |
Last Update Date: | 2010-09-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OH | 5864 | 261QS0132X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QS0132X | Ambulatory Health Care Facilities | Clinic/Center | Ophthalmologic Surgery |