Provider Demographics
NPI:1649477514
Name:KRIS A HILL OD PC
Entity type:Organization
Organization Name:KRIS A HILL OD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:D
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-569-3698
Mailing Address - Street 1:7400 UNION PARK AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-6704
Mailing Address - Country:US
Mailing Address - Phone:801-569-3698
Mailing Address - Fax:801-569-0578
Practice Address - Street 1:7400 UNION PARK AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-6704
Practice Address - Country:US
Practice Address - Phone:801-569-3698
Practice Address - Fax:801-569-0578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000058095Medicare PIN