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General NPI Number Information
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NPI Number | 1568354504
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Entity Type | Individual
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Provider Name | JESSICA MAE HILTY O.D.
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Gender | Female
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Dates
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Enumeration Date | 07/16/2025
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 291 N MILWAUKEE ST STE A-3
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City | BOISE
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State | ID
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Zip | 83704-9132
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Country | US
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Telephone | 208-378-7020
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Fax |
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Provider Business Mailing Address
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Address Line | 1812 W SILVER CREEK CT
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City | NAMPA
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State | ID
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Zip | 83686-5295
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Country | US
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Telephone | 716-237-0314
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 5871067
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License Number State | ID
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