Provider Demographics
NPI:1912085499
Name:HILL, GAILA J (OD)
Entity Type:Individual
Prefix:DR
First Name:GAILA
Middle Name:J
Last Name:HILL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:GAILA
Other - Middle Name:J
Other - Last Name:AUSTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:6 CONLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-3594
Mailing Address - Country:US
Mailing Address - Phone:719-384-4747
Mailing Address - Fax:719-384-4001
Practice Address - Street 1:6 CONLEY RD
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-9640
Practice Address - Country:US
Practice Address - Phone:719-384-4747
Practice Address - Fax:719-384-4001
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1665152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC804703Medicare PIN
COU53322Medicare UPIN