Provider Demographics
NPI:1033302765
Name:HILL, ADAM TATE (OD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:TATE
Last Name:HILL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38829
Mailing Address - Country:US
Mailing Address - Phone:662-720-1910
Mailing Address - Fax:662-720-1929
Practice Address - Street 1:108 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38829
Practice Address - Country:US
Practice Address - Phone:662-720-1910
Practice Address - Fax:662-720-1929
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS775152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist