Provider Demographics
NPI:1730741901
Name:HACKER, SCOTT ROBERT (OD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ROBERT
Last Name:HACKER
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 1:33 POPPY PL
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-9127
Mailing Address - Country:US
Mailing Address - Phone:262-909-2178
Mailing Address - Fax:
Practice Address - Street 1:400 BALD HILL RD STE 163
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1682
Practice Address - Country:US
Practice Address - Phone:401-738-9866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTG00692152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist