Provider Demographics
NPI:1700152642
Name:BICKHAM, SYLVIA DALE
Entity Type:Individual
Prefix:MRS
First Name:SYLVIA
Middle Name:DALE
Last Name:BICKHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 STRICKLAND DR STE 2
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77630-2978
Mailing Address - Country:US
Mailing Address - Phone:409-883-5956
Mailing Address - Fax:409-883-5473
Practice Address - Street 1:1502 STRICKLAND DR STE 2
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630
Practice Address - Country:US
Practice Address - Phone:409-883-5956
Practice Address - Fax:409-882-5473
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0199291-01Medicaid