Healthcare Provider Details

I. General information

NPI: 1164440046
Provider Name (Legal Business Name): HILDA YADIRA HITE O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 03/11/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 BLANDING BLVD
ORANGE PARK FL
32073-2625
US

IV. Provider business mailing address

58 BLANDING BLVD
ORANGE PARK FL
32073-2625
US

V. Phone/Fax

Practice location:
  • Phone: 904-276-5693
  • Fax: 904-276-5594
Mailing address:
  • Phone: 904-276-5693
  • Fax: 904-276-5594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPC 3592
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC 3592
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: