Provider Demographics
NPI:1184718686
Name:HILL, MICHAEL JOEL (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOEL
Last Name:HILL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 STANDISH LN
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-3237
Mailing Address - Country:US
Mailing Address - Phone:850-862-5170
Mailing Address - Fax:
Practice Address - Street 1:4310 MONTGOMERY HWY
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-1576
Practice Address - Country:US
Practice Address - Phone:334-671-9719
Practice Address - Fax:334-671-9721
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALR-150-TA-683152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist