Provider Demographics
NPI:1962011510
Name:HILLIMAN, EDMUND
Entity Type:Individual
Prefix:
First Name:EDMUND
Middle Name:
Last Name:HILLIMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3202 RIDGEWAY PL
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-1021
Mailing Address - Country:US
Mailing Address - Phone:240-687-9160
Mailing Address - Fax:410-701-7650
Practice Address - Street 1:3202 RIDGEWAY PL
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-1021
Practice Address - Country:US
Practice Address - Phone:240-687-9160
Practice Address - Fax:410-701-7650
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician