Individual provider Active NPI

David Clayton Hicks, O.D.

  • Optometrist
  • Spartanburg, SC
National Provider Identifier
1366422545
Registry record updated Nov 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1987 Issued in SC
Practice address
404 McCravy Dr Ste B
Spartanburg, SC 29303-3178
Phone
(864) 585-2249
NPI assigned
Jan 23, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 17, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1984 TN
Optometrist 152W00000X 1987 SC Primary

Addresses

Primary practice location

404 McCravy Dr Ste B
Spartanburg, SC 29303-3178

Mailing address

PO Box 1229
Saluda, NC 28773-1229
Phone (401) 222-9521

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240113000487 SC Practitioner - Optometry 7214389329 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1984TNMDAthletic Trainer

Practice roles

OrganizationSpecialtyStatusNew patients
Wilkins Opticians of Spartanburg,Inc Optometrist CurrentSince Oct 29, 2023 Accepting new patients

Locations

404 McCravy Dr
Ste B
Spartanburg, SC 29303
Phone (864) 283-9573

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1137974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700179200000",
    "number": "1366422545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1229",
            "city": "SALUDA",
            "state": "NC",
            "postal_code": "287731229",
            "telephone_number": "401-222-9521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 MCCRAVY DR STE B",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293033178",
            "telephone_number": "864-585-2249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HICKS",
        "first_name": "DAVID",
        "middle_name": "CLAYTON",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-23",
        "last_updated": "2023-11-17",
        "certification_date": "2023-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": "1984",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SC",
            "license": "1987",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spartanburg, SC

Sources for this page

Verify at the official NPI Registry.