Basic Information
| Provider Information | |||||||||
| NPI: | 1730417171 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DR HITE AND ASSOCIATES , P.A. | ||||||||
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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: | 11/23/2009 | ||||||||
| LastUpdateDate: | 11/23/2009 | ||||||||
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| AuthorizedOfficialLastName: | HITE | ||||||||
| AuthorizedOfficialFirstName: | HILDA | ||||||||
| AuthorizedOfficialMiddleName: | YADIRA | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9042765693 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | O.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OPC 3592 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 620764200 | 05 | FL | MEDICAID |