Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 528 | SD |
NPI | 1003868860 |
---|---|
Provider Name | Gregory Hill |
First Address | Davie, FL 33328-2018 |
Second Address | Davie, FL 33328-2018 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 17/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U56993 | (02) | SD |