Provider Demographics
NPI:1376686998
Name:JESSE S HICKS OD PA
Entity Type:Organization
Organization Name:JESSE S HICKS OD PA
Other - Org Name:SEEPORT OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:813-270-9277
Mailing Address - Street 1:4381 AIDAN LN
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-4917
Mailing Address - Country:US
Mailing Address - Phone:941-876-4400
Mailing Address - Fax:941-876-4390
Practice Address - Street 1:4381 AIDAN LN
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-4917
Practice Address - Country:US
Practice Address - Phone:941-876-4400
Practice Address - Fax:941-876-4390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty