Provider Demographics
NPI:1023093952
Name:HACKMAN, RICHARD (OD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:HACKMAN
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 1:3275 TITTABAWASSEE RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-9436
Mailing Address - Country:US
Mailing Address - Phone:989-399-3477
Mailing Address - Fax:989-399-3478
Practice Address - Street 1:3275 TITTABAWASSEE RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-9436
Practice Address - Country:US
Practice Address - Phone:989-399-3477
Practice Address - Fax:989-399-3478
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002744152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4527841Medicaid
0B87610011Medicare ID - Type Unspecified
MI4527841Medicaid