1790730521 NPI number — HILARY L. HAWHORNE, O.D., AN OPTOMETRIC CORPORATION

Table of content: (NPI 1790730521)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790730521 NPI number — HILARY L. HAWHORNE, O.D., AN OPTOMETRIC CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HILARY L. HAWHORNE, O.D., AN OPTOMETRIC CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790730521
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 45792
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90045-0792
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-778-7799
Provider Business Mailing Address Fax Number:
323-752-1959

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
953 W 85TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90044-4919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-778-7799
Provider Business Practice Location Address Fax Number:
323-752-1959
Provider Enumeration Date:
05/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAWTHORNE
Authorized Official First Name:
HILARY
Authorized Official Middle Name:
LISA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
323-778-7799

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  10080 TPL , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0686 . This is a "GOLDEN WEST HEALTH PLAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 43-39 . This is a "AVESIS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 3987 . This is a "FHP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 705479 . This is a "PACIFIC CARE CAMBRIDGE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 10080 . This is a "FOUNDATION HEALTH" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: SD0100800 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 115406 . This is a "EYE CARE PLAN OF AMERICA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 35493 . This is a "DAVIS VISION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 4439 . This is a "CARE 1ST HEALTH PLAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 13119 . This is a "VISION BENEFITS OF AMERIC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: E335 . This is a "EYE CARE ADMINISTRATORS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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