Provider Demographics
NPI:1235469917
Name:MICHAEL J. HILL O.D. PA
Entity Type:Organization
Organization Name:MICHAEL J. HILL O.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:850-543-2171
Mailing Address - Street 1:702 STANDISH LN
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-3237
Mailing Address - Country:US
Mailing Address - Phone:850-543-2171
Mailing Address - Fax:
Practice Address - Street 1:300 MARY ESTHER BLVD
Practice Address - Street 2:
Practice Address - City:MARY ESTHER
Practice Address - State:FL
Practice Address - Zip Code:32569-1693
Practice Address - Country:US
Practice Address - Phone:850-362-0127
Practice Address - Fax:850-664-6254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-02
Last Update Date:2010-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4326152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty