Provider Demographics
NPI:1366422545
Name:HICKS, DAVID CLAYTON (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CLAYTON
Last Name:HICKS
Suffix:
Gender:M
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 1229
Mailing Address - Street 2:
Mailing Address - City:SALUDA
Mailing Address - State:NC
Mailing Address - Zip Code:28773-1229
Mailing Address - Country:US
Mailing Address - Phone:401-222-9521
Mailing Address - Fax:
Practice Address - Street 1:404 MCCRAVY DR STE B
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3178
Practice Address - Country:US
Practice Address - Phone:864-585-2249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1984152W00000X
SC1987152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist