Provider Demographics
NPI:1780642595
Name:HILTON, JACQUELINE (OD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:HILTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1370
Mailing Address - Country:US
Mailing Address - Phone:936-569-8278
Mailing Address - Fax:936-569-0275
Practice Address - Street 1:5300 NORTH ST
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1370
Practice Address - Country:US
Practice Address - Phone:936-569-8278
Practice Address - Fax:936-569-0275
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX04663T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154712701Medicaid
TX80760QOtherBLUE CROSS BLUE SHIELD
TX80760QOtherBLUE CROSS BLUE SHIELD
TXU45772Medicare UPIN