Provider Demographics
NPI:1407413628
Name:CHEQUITA HILVERSUM, PLLC
Entity Type:Organization
Organization Name:CHEQUITA HILVERSUM, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBR/MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHEQUITA
Authorized Official - Middle Name:FARINA
Authorized Official - Last Name:HILVERSUM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:850-819-9450
Mailing Address - Street 1:4738 CHEROKEE HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-2023
Mailing Address - Country:US
Mailing Address - Phone:850-819-9450
Mailing Address - Fax:
Practice Address - Street 1:1621 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428-5992
Practice Address - Country:US
Practice Address - Phone:850-638-3214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty