Provider Demographics
NPI:1285610741
Name:HICKEY, CAROL L (OD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:L
Last Name:HICKEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:L
Other - Last Name:IRELAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:4326 CHARLESTOWN RD # 2
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-8542
Mailing Address - Country:US
Mailing Address - Phone:812-945-0023
Mailing Address - Fax:812-945-0291
Practice Address - Street 1:4326 CHARLESTOWN RD # 2
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-8542
Practice Address - Country:US
Practice Address - Phone:812-945-0023
Practice Address - Fax:812-945-0291
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003343152W00000X
KY1778DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000624031OtherBCBS
IN200502740Medicaid
IN000000624031OtherBCBS
KY7100100650Medicaid
IN5419240009Medicare NSC
KYK005500Medicare PIN
IN200502740Medicaid
IN221390GMedicare PIN