Provider Demographics
NPI:1093879470
Name:HILL, JONATHAN (OD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:HILL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:909 DANA DR
Mailing Address - Street 2:STE 2G
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-4852
Mailing Address - Country:US
Mailing Address - Phone:530-223-2240
Mailing Address - Fax:530-223-2240
Practice Address - Street 1:909 DANA DR
Practice Address - Street 2:STE 2G
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-4852
Practice Address - Country:US
Practice Address - Phone:530-223-2240
Practice Address - Fax:530-223-2240
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11061T152WC0802X, 152WP0200X, 152WS0006X, 152WX0102X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD 0110610Medicare PIN
CAU79207Medicare UPIN