Provider Demographics
NPI:1477559011
Name:HILEMAN, MATTHEW ROBERT (OD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ROBERT
Last Name:HILEMAN
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 1:1104 ADAMS ST
Mailing Address - Street 2:STE 101
Mailing Address - City:SAINT HELENA
Mailing Address - State:CA
Mailing Address - Zip Code:94574-1165
Mailing Address - Country:US
Mailing Address - Phone:707-963-7923
Mailing Address - Fax:707-963-8653
Practice Address - Street 1:1104 ADAMS ST
Practice Address - Street 2:STE 101
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574-1165
Practice Address - Country:US
Practice Address - Phone:707-963-7923
Practice Address - Fax:707-963-8653
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11888152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U91722Medicare UPIN
CA5154980001Medicare NSC
SD0118880Medicare ID - Type Unspecified