Provider Demographics
NPI:1558698837
Name:TAMMIE F HICKS OD PC
Entity Type:Organization
Organization Name:TAMMIE F HICKS OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OD
Authorized Official - Prefix:
Authorized Official - First Name:TAMMIE
Authorized Official - Middle Name:F
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-496-4774
Mailing Address - Street 1:1000 W OAKS MALL
Mailing Address - Street 2:SUITE 136
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-1733
Mailing Address - Country:US
Mailing Address - Phone:281-496-4774
Mailing Address - Fax:281-496-4782
Practice Address - Street 1:1000 W OAKS MALL
Practice Address - Street 2:SUITE 136
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-1733
Practice Address - Country:US
Practice Address - Phone:281-496-4774
Practice Address - Fax:281-496-4782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-07
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5128TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5128TGOtherTEXAS OPTOMETRY LICENSE