Healthcare Provider Details

I. General information

NPI: 1558362681
Provider Name (Legal Business Name): WILLIAM MARLIN HICKS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 HOSPITAL RD SUITE H
WINCHESTER TN
37398-2470
US

IV. Provider business mailing address

183 HOSPITAL RD SUITE H
WINCHESTER TN
37398-2470
US

V. Phone/Fax

Practice location:
  • Phone: 931-967-2230
  • Fax: 931-967-9622
Mailing address:
  • Phone: 931-967-2230
  • Fax: 931-967-9622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD 0000000494
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: