Basic Information
| Provider Information | |||||||||
| NPI: | 1164440046 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HITE | ||||||||
| FirstName: | HILDA | ||||||||
| MiddleName: | YADIRA | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 58 BLANDING BLVD | ||||||||
| Address2: | |||||||||
| City: | ORANGE PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320732625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042765693 | ||||||||
| FaxNumber: | 9042765594 | ||||||||
| Practice Location | |||||||||
| Address1: | 58 BLANDING BLVD | ||||||||
| Address2: | |||||||||
| City: | ORANGE PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320732625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042765693 | ||||||||
| FaxNumber: | 9042765594 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 03/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152WC0802X | OPC 3592 | FL | N | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management | 152W00000X | OPC 3592 | FL | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 134208447 | 01 | FL | TRICARE SOUTH REGION | OTHER |