Provider Demographics
NPI:1669447181
Name:HILLMAN, LARRY RAYMOND (OD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:RAYMOND
Last Name:HILLMAN
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 1:8972 PENSACOLA BLVD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32534-1927
Mailing Address - Country:US
Mailing Address - Phone:850-969-0100
Mailing Address - Fax:850-484-4790
Practice Address - Street 1:8972 PENSACOLA BLVD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32534-1927
Practice Address - Country:US
Practice Address - Phone:850-969-0100
Practice Address - Fax:850-484-4790
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC001929152W00000X
NC1152152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T64986Medicare UPIN
19939Medicare ID - Type Unspecified