Provider Demographics
NPI:1609945377
Name:HILLERY, KENT GEORGE (OD)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:GEORGE
Last Name:HILLERY
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 1:3343 CENTER GROVE DRIVE
Mailing Address - Street 2:CLOCK TOWER WEST
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52003-5264
Mailing Address - Country:US
Mailing Address - Phone:563-588-2093
Mailing Address - Fax:563-588-0590
Practice Address - Street 1:3343 CENTER GROVE DRIVE
Practice Address - Street 2:CLOCK TOWER WEST
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52003-5264
Practice Address - Country:US
Practice Address - Phone:563-588-2093
Practice Address - Fax:563-588-0590
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1541152W00000X
WI1379152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA07575OtherBLUE CROSS
IA0070771Medicaid
IA0070771Medicaid
IAI16782Medicare ID - Type Unspecified