Provider Demographics
NPI:1003966276
Name:HICKS, DONALD (OPAC)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:
Last Name:HICKS
Suffix:
Gender:M
Credentials:OPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4401 MIDDLE SETTLEMENT RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-5331
Mailing Address - Country:US
Mailing Address - Phone:315-735-4496
Mailing Address - Fax:315-735-7066
Practice Address - Street 1:4401 MIDDLE SETTLEMENT RD
Practice Address - Street 2:SUITE 102
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-5331
Practice Address - Country:US
Practice Address - Phone:315-735-4496
Practice Address - Fax:315-735-7066
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZX2200XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherOrthopedic Assistant