Provider Demographics
NPI:1164440046
Name:HITE, HILDA YADIRA (OD)
Entity Type:Individual
Prefix:
First Name:HILDA
Middle Name:YADIRA
Last Name:HITE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 BLANDING BLVD
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2625
Mailing Address - Country:US
Mailing Address - Phone:904-276-5693
Mailing Address - Fax:904-276-5594
Practice Address - Street 1:58 BLANDING BLVD
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-2625
Practice Address - Country:US
Practice Address - Phone:904-276-5693
Practice Address - Fax:904-276-5594
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3592152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL134208447OtherTRICARE SOUTH REGION
FL620764200Medicaid