Individual
DR. SALLY HACKING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
244 E MAIN ST, REXBURG, ID 83440-2022
(208) 359-1880
(208) 359-2025
Mailing address
244 E MAIN ST, REXBURG, ID 83440-2022
(208) 359-1880
(208) 359-2025
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP 100024
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010147629
BLUE SHIELD OF IDAHO
ID
05
—
806951200
—
ID
01
—
863683
DESERET MUTUAL
ID
01
—
V6507
BLUE CROSS OF IDAHO
ID
Enumeration date
08/23/2006
Last updated
07/09/2007
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