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Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.

MR. ADAM L HICKENBOTHAM, OD

Active Sole Proprietor

MR. ADAM L HICKENBOTHAM, OD is a Optometrist healthcare provider located in PROVO, Utah. NPI 1063462778 is currently active in the NPPES registry. Verify at CMS.

Optometrist · PROVO, UT

Registration Details

NPI Number
1063462778
Provider Type
Individual
Gender
Male
NPI Issued
May 11, 2006 (20.223770989574 yrs)
Last Updated
Dec 3, 2024
Licenses
2028DT (KY)
11993238-9934 (UT)
OPT 12423 TPA (CA)
Sole Proprietor
Yes

Practice Information

Address
122 E 1700 S BLDG 3
PROVO, UT, 846065644
Browse UT providers · Browse ZIP 84606
Phone
3852485550
Primary Specialty
Optometrist
152W00000X
Additional Specialty
Optometrist
Additional Specialty
Optometrist

Other Optometrist Providers in PROVO, UT

Name Credential NPI
DR. FRANK MIDDLETON EDMUNDS O.D. 1578560165
DR. JOE REX HAGGARD O.D. 1508863978
DR. BLAINE F BIRD O.D. 1871581652
DR. PHILLIP ANTHONY PLOTHOW OD 1235110149
DR. DELL C MORRIS OD 1619947991
DR. TODD J LEWIS OD 1801856976
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.