MEDICARE: MR. THOMAS MARK HIXSON OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	7490T	CA
2	152WC0802X	Corneal and Contact Management Optometrist	7490T	CA
3	152WL0500X	Low Vision Rehabilitation Optometrist	7490T	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528072683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS MARK HIXSON OD

Provider Business Mailing Address
First Line	:	8007 LA MESA BLVD
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91941-6434
Country	:	US
Telephone Number	:	619-466-5665
Fax Number	:	619-466-5688

Provider Business Practice Location Address
First Line	:	8007 LA MESA BLVD
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91941-6434
Country	:	US
Telephone Number	:	619-466-5665
Fax Number	:	619-466-5688

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	01/02/2009

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