Provider Demographics
NPI:1992813695
Name:HILL-BENNETT, TAMARA (OD)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:HILL-BENNETT
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1137 E MOUNT PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19150-2901
Mailing Address - Country:US
Mailing Address - Phone:215-548-2010
Mailing Address - Fax:215-548-2130
Practice Address - Street 1:1200 W GODFREY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3323
Practice Address - Country:US
Practice Address - Phone:215-276-6000
Practice Address - Fax:215-276-1329
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000255152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0474821000OtherKEYSTONE HEALTH PLAN EAST
PA0019659020001Medicaid
PA32434OtherHEALTH PARTNERS
PA04380RFXMedicare ID - Type Unspecified
PA0019659020001Medicaid