Provider Demographics
NPI:1558362681
Name:HICKS, WILLIAM MARLIN (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MARLIN
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 1:183 HOSPITAL RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-2470
Mailing Address - Country:US
Mailing Address - Phone:931-967-2230
Mailing Address - Fax:931-967-9622
Practice Address - Street 1:183 HOSPITAL RD
Practice Address - Street 2:SUITE H
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-2470
Practice Address - Country:US
Practice Address - Phone:931-967-2230
Practice Address - Fax:931-967-9622
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD 0000000494152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3722905Medicaid
T91517Medicare UPIN
TN3722905Medicaid