Healthcare Provider Details

I. General information

NPI: 1902864085
Provider Name (Legal Business Name): JAMES M TICKNER O.D., M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315A LAKE ARIEL HWY
LAKE ARIEL PA
18436-9438
US

IV. Provider business mailing address

3319 LAKE ARIEL HWY
HONESDALE PA
18431-1174
US

V. Phone/Fax

Practice location:
  • Phone: 570-698-4140
  • Fax: 570-698-4165
Mailing address:
  • Phone: 570-253-6551
  • Fax: 570-253-6553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG001159
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: