Provider Demographics
NPI:1215234745
Name:HICKNER, ZACHARY JOHN (MD)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:JOHN
Last Name:HICKNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1906 W MILHAM AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-1232
Mailing Address - Country:US
Mailing Address - Phone:269-345-1121
Mailing Address - Fax:269-345-9110
Practice Address - Street 1:1906 W MILHAM AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-1232
Practice Address - Country:US
Practice Address - Phone:269-345-1121
Practice Address - Fax:269-345-9110
Is Sole Proprietor?:No
Enumeration Date:2011-02-18
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI093190207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology