Provider Demographics
NPI:1639234024
Name:HILL, MICHAEL S (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:HILL
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 1:14377 HEARTLAND CV
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84065-6678
Mailing Address - Country:US
Mailing Address - Phone:801-446-9850
Mailing Address - Fax:
Practice Address - Street 1:148 E WINCHESTER ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7211
Practice Address - Country:US
Practice Address - Phone:801-269-8804
Practice Address - Fax:801-269-9612
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4945099-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU90644Medicare UPIN