Provider Demographics
NPI:1922413723
Name:HACKETT, DAVID ANDREW (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ANDREW
Last Name:HACKETT
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 1:4765 VILLAGE PLAZA LOOP STE 100
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6676
Mailing Address - Country:US
Mailing Address - Phone:541-342-3100
Mailing Address - Fax:541-342-6153
Practice Address - Street 1:4765 VILLAGE PLAZA LOOP STE 100
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-342-3100
Practice Address - Fax:541-342-6153
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014018414152W00000X
OR3639ATI152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152W00000XEye and Vision Services ProvidersOptometrist