Individual
KEVIN R HICKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2251 DUBOIS DR, WARSAW, IN 46580-3212
(574) 269-2777
(574) 371-4697
Mailing address
2251 DUBOIS DR, WARSAW, IN 46580-3212
(574) 269-2777
(574) 371-4697
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18002532
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100173900
—
IN
Enumeration date
05/31/2005
Last updated
02/22/2008
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