Provider Demographics
NPI:1992808513
Name:HILL, JAN HOUCK (OPTICIAN)
Entity type:Individual
Prefix:MRS
First Name:JAN
Middle Name:HOUCK
Last Name:HILL
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 NORTH MONROE ST
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-4363
Mailing Address - Country:US
Mailing Address - Phone:318-255-2801
Mailing Address - Fax:318-255-2819
Practice Address - Street 1:104 NORTH MONROE ST
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-4363
Practice Address - Country:US
Practice Address - Phone:318-255-2801
Practice Address - Fax:318-255-2819
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1161471Medicaid
LA1161471Medicaid