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General NPI Number Information
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NPI Number | 1730741901
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Entity Type | Individual
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Provider Name | SCOTT ROBERT HACKER OD
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Gender | Male
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Dates
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Enumeration Date | 07/08/2019
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Last Update Date | 02/22/2024
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Provider Practice Location Address
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Address Line | 400 BALD HILL RD STE 163
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City | WARWICK
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State | RI
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Zip | 02886-1682
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Country | US
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Telephone | 401-738-9866
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Fax |
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Provider Business Mailing Address
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Address Line | 33 POPPY PL
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City | WARWICK
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State | RI
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Zip | 02886-9127
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Country | US
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Telephone | 262-909-2178
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | ODTG00692
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License Number State | RI
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