Provider Demographics
NPI:1649376369
Name:BRANDY E HICKS OD PA
Entity type:Organization
Organization Name:BRANDY E HICKS OD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:EDALGO
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:828-586-8080
Mailing Address - Street 1:PO BOX 2218
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-2218
Mailing Address - Country:US
Mailing Address - Phone:828-586-8080
Mailing Address - Fax:828-586-8066
Practice Address - Street 1:400 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-3216
Practice Address - Country:US
Practice Address - Phone:828-586-8080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1782152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2329589Medicare ID - Type Unspecified