Provider Demographics
NPI:1114953965
Name:HICKMAN, M SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:M SCOTT
Middle Name:
Last Name:HICKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:M
Other - Middle Name:SCOTT
Other - Last Name:HICKMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1429 OREAD WEST ST STE 110A
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-5205
Mailing Address - Country:US
Mailing Address - Phone:785-424-8805
Mailing Address - Fax:
Practice Address - Street 1:1429 OREAD WEST ST STE 110A
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-5205
Practice Address - Country:US
Practice Address - Phone:785-424-8805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0432997207W00000X
KS04-32997207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS016353OtherMEDICARE PROVIDER NUMBER
1770016727OtherGROUP NPI