Provider Demographics
NPI:1568539146
Name:HILL, WILLIAM RANDOLPH (OD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RANDOLPH
Last Name:HILL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:RANDY
Other - Middle Name:
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1190 PACIFIC COAST HWY
Mailing Address - Street 2:SUITE E
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-6247
Mailing Address - Country:US
Mailing Address - Phone:562-431-2031
Mailing Address - Fax:562-594-0479
Practice Address - Street 1:1190 PACIFIC COAST HWY
Practice Address - Street 2:SUITE E
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-6247
Practice Address - Country:US
Practice Address - Phone:562-431-2031
Practice Address - Fax:562-594-0479
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8176T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWY136Medicare PIN
CAWOP8176AMedicare ID - Type UnspecifiedINDIVIDUAL PROVIDER
CAT70256Medicare UPIN