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Contact Information

ADAM L HICKENBOTHAM, OD
122 E 1700 S BLDG 3
PROVO, UT84606-5644
 Phone: 385-248-5550
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
Indicates primary specialty

NPI Profile & details for ADAM L HICKENBOTHAM · (Male)

NPI # 1063462778
Status Active
Credentials OD (Doctor of Optometry)
Entity Individual
Enumeration date 05/11/2006
Last updated 12/03/2024 - More than a year ago
Sole proprietor 1 Yes
Identifiers
  • CA License # OPT 12423 TPA
  • KY License # 2028DT
  • UT License # 11993238-9934
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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