Individual
MR. ADAM L HICKENBOTHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
122 E 1700 S BLDG 3, PROVO, UT 84606-5644
(385) 248-5550
Mailing address
147 SYCAMORE ST, PIKEVILLE, KY 41501-9118
(606) 218-5522
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
11993238-9934
UT
152W00000X
Optometrist
2028DT
KY
152W00000X
Optometrist
OPT 12423 TPA
CA
Other
Enumeration date
05/11/2006
Last updated
12/03/2024
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