MEDICARE: DR. WILLIAM MARLIN HICKS 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	OD 0000000494	TN

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	:	1558362681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM MARLIN HICKS OD

Provider Business Mailing Address
First Line	:	183 HOSPITAL RD
Second Line	:	SUITE H
City	:	WINCHESTER
State	:	TN
Zip	:	37398-2470
Country	:	US
Telephone Number	:	931-967-2230
Fax Number	:	931-967-9622

Provider Business Practice Location Address
First Line	:	183 HOSPITAL RD
Second Line	:	SUITE H
City	:	WINCHESTER
State	:	TN
Zip	:	37398-2470
Country	:	US
Telephone Number	:	931-967-2230
Fax Number	:	931-967-9622

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	09/18/2012

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