MR. ADAM L HICKENBOTHAM OD
NPI 1063462778
Optometrist in Provo, UT

Q: What is Adam Hickenbotham's NPI number?

The NPI number for Adam Hickenbotham is 1063462778. It was assigned to this individual provider in the NPPES registry on May 11, 2006.

Q: What is Adam Hickenbotham's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Q: When was this NPI record last updated?

The NPPES record for Adam Hickenbotham was last updated on December 3, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since May 11, 2006PECOS Enrolled

122 E 1700 S BLDG 3, PROVO, UT 84606(385) 248-5550 Get Directions Write a Review

NPPES record last updated: December 3, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Dec 3, 2024, Oct 12, 2016 (2 updates tracked since 2016).

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About Mr. Adam L Hickenbotham Od NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. ADAM L HICKENBOTHAM OD (NPI 1063462778) is an individual optometrist in Provo, Utah, licensed in Utah (11993238-9934) and active in the NPI registry since May 2006. He is enrolled in Medicare PECOS and maintains a secondary practice location in Slc.

NPPES Registry Identity

NPI1063462778

Entity TypeIndividualMale

Primary Taxonomy152W00000X

Provider Legal NameMR. ADAM L HICKENBOTHAMCredential: OD

Location Address122 E 1700 S BLDG 3Provo, UT 84606-5644

Mailing Address147 Sycamore StPikeville, KY 41501-9118 · (606) 218-5522

Phone(385) 248-5550

Sole ProprietorYes

Enumeration DateMay 11, 2006

Last NPPES UpdateDecember 3, 20242 updates tracked since enumeration

NPPES CertifiedDecember 3, 2024

✔ NPI 1063462778 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOptometristEye and Vision Services Providers

Taxonomy Code152W00000X

Licenses✔ Licensed in UT · 11993238-9934✔ Licensed in KY · 2028DT✔ Licensed in CA · OPT 12423 TPA

Definition

Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.

122 E 1700 S BLDG 3, Provo, UT 84606

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Secondary Practice Location 1

Location 1970 S Emery StSlc, UT 84104-2050 · Phone (385) 248-5550

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Adam L Hickenbotham Od is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 84606 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$125.70 typical visit price

range $54.34 – $166.03

Typical copayment $31.42 (range $13.58 – $41.50)

Most-billed visit code 99204

Established Patient

$68.01 typical visit price

range $17.23 – $135.20

Typical copayment $17.00 (range $4.30 – $33.80)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 9

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

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