Provider Demographics
NPI:1043210933
Name:HICKS, BRANDY E (OD)
Entity Type:Individual
Prefix:DR
First Name:BRANDY
Middle Name:E
Last Name:HICKS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2218
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-2218
Mailing Address - Country:US
Mailing Address - Phone:828-586-8080
Mailing Address - Fax:828-586-8066
Practice Address - Street 1:400 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-3216
Practice Address - Country:US
Practice Address - Phone:828-586-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC 1782152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0929KOtherBLUE CROSS & BLUE SHIELD
NC890929KMedicaid
NC890929KMedicaid
NCU78477Medicare UPIN