Adam L Hickenbotham, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

11993238-9934 Issued in UT

Practice address

122 E 1700 S BLDG 3
Provo, UT 84606-5644

Phone

(385) 248-5550

NPI assigned

May 11, 2006

Last updated

Dec 3, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• UT PPO D-SNP
• UT PPO

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Complete Eye Care

  dba Orem Eye Clinic

  • Optometrist
  • Orem, UT
  • NPI 1871950444
  NPD
• Rocky Mountain University of Health Professions Foundation

  • Physical Therapist
  • Provo, UT
  • NPI 1053174417

  Optometrist

  NPD
• Loren Donnell Smith OD Inc

  • Clinic/Center
  • Newark, CA
  • NPI 1649692575
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733184000000",
    "number": "1063462778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "147 SYCAMORE ST",
            "city": "PIKEVILLE",
            "state": "KY",
            "postal_code": "415019118",
            "telephone_number": "606-218-5522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 E 1700 S BLDG 3",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846065644",
            "telephone_number": "385-248-5550"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "970 S Emery St",
            "address_purpose": "LOCATION",
            "city": "Slc",
            "state": "UT",
            "postal_code": "841042050",
            "country_code": "US",
            "telephone_number": "385-248-5550",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HICKENBOTHAM",
        "first_name": "ADAM",
        "middle_name": "L",
        "name_prefix": "Mr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-11",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KY",
            "license": "2028DT",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "UT",
            "license": "11993238-9934",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT 12423 TPA",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brandon Hiatt
• Summer Hibbard
• Allison Hibbits
• Chelsey Hicken
• Lacy Hicken, SSW
• Ericka Marchelle Hickman, LCSW
• Jessica Hidalgo
• Brett Higbee, PA
• Cade Higbee
• Michael G. Higbee, LCSW

• Optometrist in Provo, UT
• Providers in Provo, UT by specialty
• Optometrist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.