Provider Demographics
NPI:1669454856
Name:HILL, BILLY WAYNE (OD)
Entity type:Individual
Prefix:DR
First Name:BILLY
Middle Name:WAYNE
Last Name:HILL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:205A WEST OKMULGEE
Mailing Address - Street 2:
Mailing Address - City:CHECOTAH
Mailing Address - State:OK
Mailing Address - Zip Code:74426-2408
Mailing Address - Country:US
Mailing Address - Phone:918-473-2308
Mailing Address - Fax:918-473-2961
Practice Address - Street 1:205A WEST OKMULGEE
Practice Address - Street 2:
Practice Address - City:CHECOTAH
Practice Address - State:OK
Practice Address - Zip Code:74426-2408
Practice Address - Country:US
Practice Address - Phone:918-473-2308
Practice Address - Fax:918-473-2961
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1083152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0170540001OtherDMERC
OK410002358OtherRAILROAD MEDICARE
OK100762010AMedicaid
OKA002OtherCHAMPVA
OK731227583001OtherBLUE CROSS BLUE SHIELD
OK731227583001OtherBLUE CROSS BLUE SHIELD