Healthcare Provider Details

I. General information

NPI: 1093879470
Provider Name (Legal Business Name): JONATHAN HILL O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 05/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 DANA DR STE 2G
REDDING CA
96003-4852
US

IV. Provider business mailing address

909 DANA DR STE 2G
REDDING CA
96003-4852
US

V. Phone/Fax

Practice location:
  • Phone: 530-223-2240
  • Fax: 530-223-2240
Mailing address:
  • Phone: 530-223-2240
  • Fax: 530-223-2240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number11061T
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number11061T
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number11061T
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number11061T
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11061T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: