Provider Demographics
NPI:1457558041
Name:HILLIS, KRISTEN ELIZABETH HASKINS (OD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:ELIZABETH HASKINS
Last Name:HILLIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:ELIZABETH
Other - Last Name:HASKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8614 WESTWOOD CENTER DR
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:100 NORTH AVE
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3417
Practice Address - Country:US
Practice Address - Phone:269-962-7595
Practice Address - Fax:269-963-9202
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD0000002690152W00000X, 152WP0200X, 152WS0006X, 152WV0400X
MI4901005426152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy