Healthcare Provider Details

I. General information

NPI: 1477592384
Provider Name (Legal Business Name): JESSICA D HILDENBRAND OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 CEI DRIVE
CINCINNATI OH
45242-3311
US

IV. Provider business mailing address

4445 LAKE FOREST DR STE 600
BLUE ASH OH
45242-3744
US

V. Phone/Fax

Practice location:
  • Phone: 513-569-3741
  • Fax: 513-569-3941
Mailing address:
  • Phone: 513-569-3741
  • Fax: 513-569-3941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1410DT
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4938T1808
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: