Provider Demographics
NPI:1982953899
Name:HILL-PARKS, TRICIA
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:HILL-PARKS
Suffix:
Gender:F
Credentials:
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 4907
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59806-7000
Mailing Address - Country:US
Mailing Address - Phone:406-363-3366
Mailing Address - Fax:406-363-2223
Practice Address - Street 1:120 SOUTH 5TH STREET
Practice Address - Street 2:STE 105
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-9840
Practice Address - Country:US
Practice Address - Phone:406-363-3366
Practice Address - Fax:406-363-2223
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT3958870001Medicare PIN