MR. ADAM L HICKENBOTHAM (OD) – Optometrist, NPI 1063462778
Optometrist
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for MR. ADAM L HICKENBOTHAM (OD)
970 S Emery St
Slc, UT 841042050
Phone: (385) 248-5550
Type: Location
University of Pikeville, 147, Sycamore Street, Pikeville, Pike County, Kentucky, 41501, United States
PIKEVILLE, KY 415019118
Phone: (606) 218-5522
Type: Mailing
122 E 1700 S BLDG 3
PROVO, UT 846065644
Phone: (385) 248-5550
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 9 Open Payments records for all available years, with a total value of $364.
Total Amount is formed as General ($364) + Research ($0) + Ownership ($0) = $364.
Last reported payment date: 2024-11-11 • Largest payer in this snapshot: ABBVIE INC. ($155).
Total Amount
$364
General + Research + Ownership
Payments
9
Total payment records
General Amount
$364
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-11
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ABBVIE INC. | $155 |
| LKC Technologies, Inc. | $73 |
| BIOTISSUE HOLDINGS INC. | $51 |
| Reliance Medical Products, Inc. | $26 |
| Alcon Vision LLC | $24 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2022-09-26
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20220926002120 | I | Optometry | UT | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 84104)
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