| Doctor Name: | DR. ALISA KOURTNEY HICKMAN |
| NPI Number: | 1790186211 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | OD |
| License Number: | OEG003002 |
| Business Practice Address: | 1400 Vfw Pkwy Eye Clinic West Roxbury, MA - 021324927 |
| Business Phone Number: | 8572035438 |
| Business Fax Number: | 8572035706 |
| Mailing Address: | 1400 Vfw Pkwy, Eye Clinic WEST ROXBURY |
| State: | MA |
| Postal Code: | 021324927 |
| Phone Number: | 8572035438 |
| Fax Number: | 8572035706 |
| NPI Enumeration Date: | 09/16/2014 |
| NPI Last Update Date: | 09/16/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | OEG003002 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |