IndividualActive
Adam Hickenbotham, OD
NPI 1063462778 · Optometrist · Provo, UT
Provider details
- NPI number
- 1063462778
- Entity type
- Individual
- Primary specialty
- OptometristEye and Vision Services Providers
- Credential
- OD
- Sex
- Male
- Sole proprietor
- Yes
- License
- 2028DT (KY)
Mailing address
147 Sycamore St
Pikeville, KY 41501-9118
Registry dates
- Enumerated
- 2006-05-11
- Last updated
- 2024-12-03
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.