Provider Demographics
NPI:1801939186
Name:HIXSON, DOUGLAS BYRON (O D)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:BYRON
Last Name:HIXSON
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:815 N MCKENZIE ST
Mailing Address - Street 2:B
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-3526
Mailing Address - Country:US
Mailing Address - Phone:251-943-5115
Mailing Address - Fax:251-943-5117
Practice Address - Street 1:815 N MCKENZIE ST
Practice Address - Street 2:B
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-3526
Practice Address - Country:US
Practice Address - Phone:251-943-5115
Practice Address - Fax:251-943-5117
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS324 TA428152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALT68939Medicare UPIN