MEDICARE: DR. KENT GEORGE HILLERY OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1541	IA
2	152W00000X	Optometrist	1379	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	07575	OTHER	IA	BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609945377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENT GEORGE HILLERY OD

Provider Business Mailing Address
First Line	:	3343 CENTER GROVE DRIVE
Second Line	:	CLOCK TOWER WEST
City	:	DUBUQUE
State	:	IA
Zip	:	52003-5264
Country	:	US
Telephone Number	:	563-588-2093
Fax Number	:	563-588-0590

Provider Business Practice Location Address
First Line	:	3343 CENTER GROVE DRIVE
Second Line	:	CLOCK TOWER WEST
City	:	DUBUQUE
State	:	IA
Zip	:	52003-5264
Country	:	US
Telephone Number	:	563-588-2093
Fax Number	:	563-588-0590

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	07/08/2007

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