Provider Demographics
NPI:1578543377
Name:HISLE, WILLA ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLA
Middle Name:ANN
Last Name:HISLE
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:17571 VIERRA CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93907-3311
Mailing Address - Country:US
Mailing Address - Phone:831-663-3276
Mailing Address - Fax:831-663-3277
Practice Address - Street 1:17571 VIERRA CANYON RD
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93907-3311
Practice Address - Country:US
Practice Address - Phone:831-663-3276
Practice Address - Fax:831-663-3277
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA9982152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0099820Medicaid
CASD0099821Medicare PIN