Provider Demographics
NPI:1770927212
Name:HACK, ANDREW ERNEST (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:ERNEST
Last Name:HACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-5608
Mailing Address - Country:US
Mailing Address - Phone:864-269-3333
Mailing Address - Fax:864-295-1288
Practice Address - Street 1:113 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-5608
Practice Address - Country:US
Practice Address - Phone:864-269-3333
Practice Address - Fax:864-295-1288
Is Sole Proprietor?:No
Enumeration Date:2013-04-27
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK32807207W00000X
SC51662207WX0120X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC516622Medicaid