Provider Demographics
NPI:1801939509
Name:HICKS, JESSE S (OD)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:S
Last Name:HICKS
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1299 N SUMTER BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34286-8021
Mailing Address - Country:US
Mailing Address - Phone:941-876-4400
Mailing Address - Fax:941-876-4390
Practice Address - Street 1:1299 N SUMTER BLVD
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34286-8021
Practice Address - Country:US
Practice Address - Phone:941-876-4400
Practice Address - Fax:941-876-4390
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3897152W00000X
FLOPC 3897152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist