Provider Demographics
NPI:1972683878
Name:HILE, KERRY A (OD)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:A
Last Name:HILE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KERRY
Other - Middle Name:A
Other - Last Name:O'BRIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:801 VASSAR DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2725
Mailing Address - Country:US
Mailing Address - Phone:505-248-4005
Mailing Address - Fax:505-248-4093
Practice Address - Street 1:801 VASSAR DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2725
Practice Address - Country:US
Practice Address - Phone:505-248-4005
Practice Address - Fax:505-248-4093
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1161152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ556772Medicaid
AZU97515Medicare UPIN