Healthcare Provider Details

I. General information

NPI: 1235235656
Provider Name (Legal Business Name): ANDREW JAMES HILL O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 S BERKLEY ST
LOUISBURG KS
66053-3578
US

IV. Provider business mailing address

PO BOX 397
LOUISBURG KS
66053-0397
US

V. Phone/Fax

Practice location:
  • Phone: 913-837-3636
  • Fax: 913-837-5641
Mailing address:
  • Phone: 913-837-3636
  • Fax: 913-837-5641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1481-3
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: