Healthcare Provider Details

I. General information

NPI: 1326956897
Provider Name (Legal Business Name): HILLARY MARGARET WALLDROFF ABOC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25737 US ROUTE 11
EVANS MILLS NY
13637-3221
US

IV. Provider business mailing address

25737 US ROUTE 11
EVANS MILLS NY
13637-3221
US

V. Phone/Fax

Practice location:
  • Phone: 315-629-4316
  • Fax: 315-629-4319
Mailing address:
  • Phone: 315-629-4316
  • Fax: 315-629-4319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: