Sally Hacking, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

ODP 100024 Issued in ID

Practice address

244 E Main St
Rexburg, ID 83440-2022

Phone

(208) 359-1880

Fax

(208) 359-2025

NPI assigned

Aug 23, 2006

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Pacific University - College of Optometry, 2001

Medicare assignment

May accept Medicare assignment

Group practices

Madison Clinic Optometry, P.C.Group PAC ID 8426026030, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Madison Clinic Optometry, P.C.

  • Optometrist
  • Rexburg, ID
  • NPI 1598876997
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1609982271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "244 E MAIN ST",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834402022",
            "telephone_number": "208-359-1880",
            "fax_number": "208-359-2025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "244 E MAIN ST",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834402022",
            "telephone_number": "208-359-1880",
            "fax_number": "208-359-2025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HACKING",
        "first_name": "SALLY",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-23",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP 100024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DESERET MUTUAL",
            "identifier": "863683",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF IDAHO",
            "identifier": "000010147629",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806951200",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "V6507",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michele Ann Griggs
• Hayley Brooke Grover, FNP-C
• Jeffrey T Grover, CRNA
• Zachary Rex Gundersen, PHARMD
• Layne E Hacking, DMD
• Emily Hackworth
• Joseph Michael Haeberle, NP
• Mark S. Hammar, PA-C
• Carolyn Huntsman Hammer
• Justin Hammer, DPT

• Optometrist in Rexburg, ID
• Providers in Rexburg, ID by specialty
• Optometrist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.