Provider Demographics
NPI:1164531109
Name:HICKS, RANDEL STERLING (OD)
Entity Type:Individual
Prefix:
First Name:RANDEL
Middle Name:STERLING
Last Name:HICKS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 SW 89TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-7902
Mailing Address - Country:US
Mailing Address - Phone:405-692-2526
Mailing Address - Fax:405-692-2187
Practice Address - Street 1:3200 SW 89TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-7902
Practice Address - Country:US
Practice Address - Phone:405-692-2526
Practice Address - Fax:405-692-2187
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK923152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100761420BMedicaid
OK100761420BMedicaid
OK4472620001Medicare NSC