Provider Demographics
NPI:1629057203
Name:HICKSON, HEATHER L (OD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:L
Last Name:HICKSON
Suffix:
Gender:F
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:PO BOX 1195
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-1195
Mailing Address - Country:US
Mailing Address - Phone:828-687-7500
Mailing Address - Fax:828-687-7333
Practice Address - Street 1:140 AIRPORT RD
Practice Address - Street 2:SUITE L
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-8599
Practice Address - Country:US
Practice Address - Phone:828-687-7500
Practice Address - Fax:828-687-7333
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1812152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89093G9Medicaid
NCU86747Medicare UPIN
NC2471875Medicare ID - Type UnspecifiedASHEVILLE FAMILY EYE MC
NC2471875BMedicare ID - Type UnspecifiedMEDICARE NUMBER--ELITE