Provider Demographics
NPI:1265524565
Name:HILL, JEFFREY (OD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
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 1:2129 SW WANAMAKER RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-5213
Mailing Address - Country:US
Mailing Address - Phone:785-272-6737
Mailing Address - Fax:
Practice Address - Street 1:2129 SW WANAMAKER RD
Practice Address - Street 2:SUITE B
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-5213
Practice Address - Country:US
Practice Address - Phone:785-272-6737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1375152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS065097OtherBLUE CROSS BLUE SHIELD
KS416630OtherFIRSTGUARD
KS065097OtherBLUE CROSS BLUE SHIELD