Provider Demographics
NPI:1245285113
Name:HAWTHORNE, HILARY LISA (OD)
Entity type:Individual
Prefix:
First Name:HILARY
Middle Name:LISA
Last Name:HAWTHORNE
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:PO BOX 45792
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-0792
Mailing Address - Country:US
Mailing Address - Phone:323-778-7799
Mailing Address - Fax:323-752-1959
Practice Address - Street 1:8619 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-4827
Practice Address - Country:US
Practice Address - Phone:323-778-7799
Practice Address - Fax:323-752-1959
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10080 TPL152W00000X
CA10080TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0686OtherGOLDEN WEST HEALTH PLAN
CA115406OtherEYE CARE PLAN OF AMERICA
CA12763-7799OtherMEDICAL EYE SERVICES
CA990014591OtherUNITED HEALTHCARE INS. CO
CA3987OtherFHP
CA4439OtherCARE 1ST HEALTH PLAN
CAE335OtherEYE CARE ADMINISTRATORS
CA10080OtherFOUNDATION HEALTH
CA35493OtherDAVIS VISION
CA43-39OtherAVESIS
CA13119OtherVISION BENEFITS OF AMERIC
CA705479OtherPACIFIC CARE CAMBRIDGE
CASD010080Medicaid
CAMH654916OtherDEA NUMBER
CAOP10080Medicare PIN
CAE335OtherEYE CARE ADMINISTRATORS
CAMH654916OtherDEA NUMBER
CA4439OtherCARE 1ST HEALTH PLAN