Provider Demographics
NPI:1730351966
Name:JONATHAN HILL OD AN OPTOMETRIC CORPORATION
Entity type:Organization
Organization Name:JONATHAN HILL OD AN OPTOMETRIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HORROCKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-319-9269
Mailing Address - Street 1:743 TEAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003
Mailing Address - Country:US
Mailing Address - Phone:530-244-7758
Mailing Address - Fax:
Practice Address - Street 1:909 DANA DR STE 2G
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-4852
Practice Address - Country:US
Practice Address - Phone:530-223-2240
Practice Address - Fax:530-226-7483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11061T152WC0802X, 152WP0200X, 152WS0006X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU79207Medicare UPIN
CAZZZ25915ZMedicare PIN