Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | SC1228 | OH |
NPI | 1023141629 |
---|---|
Provider Name | Mr. Thomas Scott Hicks |
First Address | Oxford, OH 45056-1710 |
Second Address | Oxford, OH 45056-1710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2007 |
Last Update Date | 28/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0635170001 | (02) | OH |