Provider Demographics
NPI:1164420972
Name:HILL, KENT B (OD)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:B
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 1:507 S LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:MO
Mailing Address - Zip Code:63084-2121
Mailing Address - Country:US
Mailing Address - Phone:636-583-3322
Mailing Address - Fax:636-583-8328
Practice Address - Street 1:507 S LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MO
Practice Address - Zip Code:63084-2121
Practice Address - Country:US
Practice Address - Phone:636-583-3322
Practice Address - Fax:636-583-8328
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02166152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO311336309Medicaid
MO0434960001Medicare NSC
MO000006741Medicare ID - Type Unspecified
MO311336309Medicaid