Provider Demographics
NPI:1982613865
Name:HILL, ANGELA D (OD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:D
Last Name:HILL
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 1:7400 UNION PARK AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-6704
Mailing Address - Country:US
Mailing Address - Phone:801-569-3698
Mailing Address - Fax:801-569-0578
Practice Address - Street 1:7400 UNION PARK AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-6704
Practice Address - Country:US
Practice Address - Phone:801-569-3698
Practice Address - Fax:801-569-0578
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5676170-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005809502Medicare ID - Type Unspecified
UTV01433Medicare UPIN