Individual
LARRY W. HICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
900 N SUMNER AVE, CRESTON, IA 50801-1351
(641) 782-5970
(641) 782-2756
Mailing address
900 N SUMNER AVE, CRESTON, IA 50801-1351
(641) 782-5970
(641) 782-2756
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
01473
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0050625
—
IA
Enumeration date
08/29/2006
Last updated
02/01/2010
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