Provider Demographics
NPI:1447387733
Name:KENNETH R. HILL, O.D.
Entity Type:Organization
Organization Name:KENNETH R. HILL, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNENTH
Authorized Official - Middle Name:R
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-446-3171
Mailing Address - Street 1:316 W 71ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74132
Mailing Address - Country:US
Mailing Address - Phone:918-446-3171
Mailing Address - Fax:
Practice Address - Street 1:316 W 71ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74132-2008
Practice Address - Country:US
Practice Address - Phone:918-446-3171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK830332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100764260Medicaid
OK0627360001Medicare NSC