Healthcare Provider Details

I. General information

NPI: 1457558041
Provider Name (Legal Business Name): KRISTEN ELIZABETH HASKINS HILLIS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN ELIZABETH HASKINS

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 02/23/2024
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NORTH AVE
BATTLE CREEK MI
49017-3417
US

IV. Provider business mailing address

8614 WESTWOOD CENTER DR
VIENNA VA
22182-2442
US

V. Phone/Fax

Practice location:
  • Phone: 269-962-7595
  • Fax: 269-963-9202
Mailing address:
  • Phone: 703-847-8899
  • Fax: 571-223-6780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD0000002690
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberOD0000002690
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License NumberOD0000002690
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberOD0000002690
License Number StateTN
# 5
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901005426
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: