Provider Demographics
NPI:1467593186
Name:SILLS, JON (OD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:SILLS
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 1:4601 TELEPHONE RD STE 109
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-5671
Mailing Address - Country:US
Mailing Address - Phone:805-642-4185
Mailing Address - Fax:805-647-7467
Practice Address - Street 1:4601 TELEPHONE RD STE 109
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-5671
Practice Address - Country:US
Practice Address - Phone:805-642-4185
Practice Address - Fax:805-642-4416
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6804152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOP6804AMedicare PIN
CAT10412Medicare UPIN