Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mr. Adam L Hickenbotham, OD

Individual provider Optometrist · NPI 1063462778

Mr. Adam L Hickenbotham, OD is an Optometrist in Provo, Utah. Practices as a sole proprietor and works from 2 locations. Licensed in California, Kentucky and Utah.

Licensed in
CA, KY, UT
In the registry since
2006
Specialties on file
3
What do these letters mean?
OD — Doctor of Optometry
An optometrist: examines eyes, prescribes glasses and contacts, and treats many eye conditions.

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Practice location Address checks out

122 E 1700 S Bldg 3
Provo, UT 84606-5644
Phone: (385) 248-5550
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 970 S Emery St, Slc, UT 84104-2050 — (385) 248-5550

Specialties & licences

Optometrist (primary) Taxonomy 152W00000X · Licence 11993238-9934 (UT)
Optometrist Taxonomy 152W00000X · Licence 2028DT (KY)
Optometrist Taxonomy 152W00000X · Licence OPT 12423 TPA (CA)

Record details

NPI number1063462778
Entity typeIndividual (Type 1)
GenderMale
Credentials OD
Sole proprietorYes
NPI enumeratedMay 11, 2006
Last updated in NPPESDecember 3, 2024
Certification dateDecember 3, 2024

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