Individual
MS. CHEQUITA HILVERSUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
212 STATE ROAD 312, ST AUGUSTINE, FL 32086-4241
(904) 824-2021
(904) 824-2039
Mailing address
1950 OLD GALLOWS RD, VIENNA, VA 22182-3990
(703) 847-8899
(571) 223-6780
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
OPC-2951
FL
152W00000X
Optometrist
Primary
OPC2951
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
59359043
TRICARE
FL
Enumeration date
10/20/2005
Last updated
04/22/2022
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