Healthcare Provider Details

I. General information

NPI: 1730351966
Provider Name (Legal Business Name): JONATHAN HILL OD AN OPTOMETRIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

743 TEAKWOOD DR
REDDING CA
96003
US

V. Phone/Fax

Practice location:
  • Phone: 530-223-2240
  • Fax: 530-226-7483
Mailing address:
  • Phone: 530-244-7758
  • Fax:

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 TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11061T
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JULIANNA HORROCKS
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 530-319-9269