Individual
ANN M HICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D., M.S.
Contact information
Practice address
237 RADIO DR STE 100, WOODBURY, MN 55125-4478
(651) 275-3000
(651) 275-3027
Mailing address
1719 TOWER DR W, STE 100, STILLWATER, MN 55082-7512
(651) 275-3000
(651) 275-3027
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2904
MN
152WP0200X
Pediatric Optometrist
2904
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
248600800
—
MN
01
—
P00125285
RAILROAD MEDICARE
MN
Enumeration date
06/15/2005
Last updated
05/14/2020
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