NPI 1063462778

Adam L Hickenbotham, OD

Practitioner Optometrist Provo, UT

Practice location

Address: 122 E 1700 S Bldg 3, Provo, UT 84606-5644
Phone: (385) 248-5550
Mailing address: 147 Sycamore St, Pikeville, KY 41501-9118

Registered specialties (3)

Optometrist Primary

Eye and Vision Services Providers Taxonomy 152W00000X Licence 11993238-9934 (UT)

Other Optometrist providers in Utah →

Optometrist

Eye and Vision Services Providers Taxonomy 152W00000X Licence 2028DT (KY)

Optometrist

Eye and Vision Services Providers Taxonomy 152W00000X Licence OPT 12423 TPA (CA)

Registry record

NPI: 1063462778
Entity type: Individual
Sex (as registered): Male
NPI issued: 11 May 2006
Record last updated: 3 Dec 2024

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.