Provider Demographics
NPI:1174879100
Name:PRILLIMAN, JILL M (OD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:PRILLIMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:M
Other - Last Name:HUELSKAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1851 N WEBB RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3413
Mailing Address - Country:US
Mailing Address - Phone:316-858-3831
Mailing Address - Fax:316-858-3830
Practice Address - Street 1:135 S ANDOVER RD
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:KS
Practice Address - Zip Code:67002-8037
Practice Address - Country:US
Practice Address - Phone:316-733-4322
Practice Address - Fax:316-733-5860
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1919152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist