Provider Demographics
NPI:1427126986
Name:FICKES, TOM (OD)
Entity type:Individual
Prefix:DR
First Name:TOM
Middle Name:
Last Name:FICKES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:744 FOREST HILLS DR
Mailing Address - Street 2:
Mailing Address - City:ROGUE RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97537-9664
Mailing Address - Country:US
Mailing Address - Phone:541-471-2070
Mailing Address - Fax:541-582-2600
Practice Address - Street 1:135 NE TERRY LN
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-4801
Practice Address - Country:US
Practice Address - Phone:541-471-2070
Practice Address - Fax:541-582-2600
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4030T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU60176Medicare UPIN