Provider Demographics
NPI:1972609972
Name:HACKNEY, TODD (O D)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:HACKNEY
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 FOREST CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-5614
Mailing Address - Country:US
Mailing Address - Phone:435-503-2420
Mailing Address - Fax:
Practice Address - Street 1:150 FOREST CREEK PKWY
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-5614
Practice Address - Country:US
Practice Address - Phone:435-503-2420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3858152W00000X
UT94-277458-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000090450Medicare ID - Type UnspecifiedUTAH MEDICARE
UT4200440001Medicare UPIN