Provider Demographics
NPI:1821301672
Name:HILL VISION PLLC
Entity Type:Organization
Organization Name:HILL VISION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:CLARY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-704-4653
Mailing Address - Street 1:316 W 71ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74132-2008
Mailing Address - Country:US
Mailing Address - Phone:918-446-3171
Mailing Address - Fax:918-446-5938
Practice Address - Street 1:316 W 71ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74132-2008
Practice Address - Country:US
Practice Address - Phone:918-446-3171
Practice Address - Fax:918-446-5938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-22
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2516152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK6627850001Medicare NSC
OKOKB6048Medicare PIN