Provider Demographics
NPI:1497873160
Name:HIMELICK, MAX D (OD)
Entity Type:Individual
Prefix:DR
First Name:MAX
Middle Name:D
Last Name:HIMELICK
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 1:4200 PORTSMOUTH BLVD
Mailing Address - Street 2:SUITE 89
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-2100
Mailing Address - Country:US
Mailing Address - Phone:757-465-8788
Mailing Address - Fax:
Practice Address - Street 1:4200 PORTSMOUTH BLVD
Practice Address - Street 2:SUITE 89
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-2100
Practice Address - Country:US
Practice Address - Phone:757-465-8788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000498152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist