Provider Demographics
NPI:1417938317
Name:HILL, RICHARD LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LEE
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 1:4207 GLASS RD NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402
Mailing Address - Country:US
Mailing Address - Phone:319-366-4455
Mailing Address - Fax:319-362-8461
Practice Address - Street 1:4207 GLASS RD NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402
Practice Address - Country:US
Practice Address - Phone:319-366-4455
Practice Address - Fax:319-362-8461
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01519152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA44560OtherWELLMARK BLUE CROSS BLUE
IAIA0101OtherJOHN DEERE HEALTH
IA5221639OtherAETNA US HEALTHCARE
IA8144OtherMIDLANDS CHOICE
IA2073601Medicaid
IA2140694OtherFIRST HEALTH
IAI0598Medicare ID - Type Unspecified
T00578Medicare UPIN
IA2140694OtherFIRST HEALTH