Provider Demographics
NPI:1265544464
Name:HICKS, WILLIAM ERIC (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ERIC
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:PO BOX 766
Mailing Address - Street 2:
Mailing Address - City:PELL CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35125-0766
Mailing Address - Country:US
Mailing Address - Phone:205-338-7411
Mailing Address - Fax:205-338-9453
Practice Address - Street 1:2811 DR JOHN HAYNES DR
Practice Address - Street 2:SUITE 103
Practice Address - City:PELL CITY
Practice Address - State:AL
Practice Address - Zip Code:35125-1447
Practice Address - Country:US
Practice Address - Phone:205-338-7411
Practice Address - Fax:205-338-9453
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS434152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000059574Medicaid
000059574Medicare PIN
000059574Medicare ID - Type Unspecified
T68935Medicare UPIN
0133830001Medicare NSC