MEDICARE: DR. DONTE HICKS O.D.

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	8418TG	TX

General Provider Information

NPI Number	:	1528474996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONTE HICKS O.D.

Provider Business Mailing Address
First Line	:	PO BOX 732973
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75373-2973
Country	:	US
Telephone Number	:	817-702-8450
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 CIRCLE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76119-8138
Country	:	US
Telephone Number	:	817-702-7340
Fax Number	:

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

Provider Enumeration Date	:	07/07/2014
Last Update Date	:	03/14/2019

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