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NPI Code Detail

MEDICARE: JAMES A HACKELY OD, LLC

MEDICARE: JAMES A HACKELY OD, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QS0132XOphthalmologic Surgery Clinic/Center5864OH

General Provider Information

NPI Number : 1760791396
Entity Type Code : Organization
Provider Name (Legal Business Name) : JAMES A HACKELY OD, LLC
Provider Business Mailing Address
First Line : 1150 POLARIS PKWY
Second Line :
City : COLUMBUS
State : OH
Zip : 43240-2024
Country : US
Telephone Number : 614-847-3912
Fax Number : 614-847-4138
Provider Business Practice Location Address
First Line : 1150 POLARIS PKWY
Second Line :
City : COLUMBUS
State : OH
Zip : 43240-2024
Country : US
Telephone Number : 614-847-3912
Fax Number : 614-847-4138
Authorized Official
Title or Position : OPTOMETRIST
Name : DR. JAMES AARON HACKLEY
Credential : O.D.
Telephone Number : 614-847-3912
Provider Enumeration Date : 09/30/2010
Last Update Date : 09/30/2010

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