Provider Demographics
NPI:1932192697
Name:HAYS, JILL K (OD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:K
Last Name:HAYS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 24TH STREET
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-5300
Mailing Address - Country:US
Mailing Address - Phone:309-788-0604
Mailing Address - Fax:309-788-0611
Practice Address - Street 1:2501 24TH STREET
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-5300
Practice Address - Country:US
Practice Address - Phone:309-788-0604
Practice Address - Fax:309-788-0611
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009112152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046009112Medicaid
U74596Medicare UPIN
IL536460Medicare PIN