Provider Demographics
NPI: | 1669454856 |
---|---|
Name: | HILL, BILLY WAYNE (OD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | BILLY |
Middle Name: | WAYNE |
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: | 205A WEST OKMULGEE |
Mailing Address - Street 2: | |
Mailing Address - City: | CHECOTAH |
Mailing Address - State: | OK |
Mailing Address - Zip Code: | 74426-2408 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 918-473-2308 |
Mailing Address - Fax: | 918-473-2961 |
Practice Address - Street 1: | 205A WEST OKMULGEE |
Practice Address - Street 2: | |
Practice Address - City: | CHECOTAH |
Practice Address - State: | OK |
Practice Address - Zip Code: | 74426-2408 |
Practice Address - Country: | US |
Practice Address - Phone: | 918-473-2308 |
Practice Address - Fax: | 918-473-2961 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2005-11-15 |
Last Update Date: | 2014-03-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OK | 1083 | 152W00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 152W00000X | Eye and Vision Services Providers | Optometrist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OK | 0170540001 | Other | DMERC |
OK | 410002358 | Other | RAILROAD MEDICARE |
OK | 100762010A | Medicaid | |
OK | A002 | Other | CHAMPVA |
OK | 731227583001 | Other | BLUE CROSS BLUE SHIELD |
OK | 731227583001 | Other | BLUE CROSS BLUE SHIELD |