Provider Demographics
NPI:1740205244
Name:HILL, STEVE WESLEY (ABOC)
Entity Type:Individual
Prefix:MR
First Name:STEVE
Middle Name:WESLEY
Last Name:HILL
Suffix:
Gender:M
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 W 26TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-0322
Mailing Address - Country:US
Mailing Address - Phone:417-781-9999
Mailing Address - Fax:417-781-9999
Practice Address - Street 1:1627 W 26TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-0322
Practice Address - Country:US
Practice Address - Phone:417-781-9999
Practice Address - Fax:417-781-9999
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO36843 ABO CERT.#156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOEYEMEDOtherPENDING
MO5598190001Medicare ID - Type UnspecifiedPOST CATARACT EYEGLASSES