Provider Demographics
NPI:1629057203
Name:HICKSON, HEATHER L (OD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:L
Last Name:HICKSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 68066
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-8066
Mailing Address - Country:US
Mailing Address - Phone:828-279-3300
Mailing Address - Fax:520-639-6595
Practice Address - Street 1:6691 N THORNYDALE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2737
Practice Address - Country:US
Practice Address - Phone:520-395-2619
Practice Address - Fax:520-308-4524
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2166152W00000X
NC1812152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89093G9Medicaid
NCU86747Medicare UPIN
NC2471875Medicare ID - Type UnspecifiedASHEVILLE FAMILY EYE MC
NC2471875BMedicare ID - Type UnspecifiedMEDICARE NUMBER--ELITE