Provider Demographics
NPI:1679812853
Name:REBECCA C HILL OD PA
Entity Type:Organization
Organization Name:REBECCA C HILL OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:C
Authorized Official - Last Name:HILL-MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:561-738-0111
Mailing Address - Street 1:232 SUDBURY DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1126
Mailing Address - Country:US
Mailing Address - Phone:561-738-0111
Mailing Address - Fax:561-735-9359
Practice Address - Street 1:2244 N CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8604
Practice Address - Country:US
Practice Address - Phone:561-738-0111
Practice Address - Fax:561-735-9359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2673152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001861700Medicaid