Matthew David Wickham, OD Valid NPI

Individual provider · Optometrist · O Fallon, MO

NPI

1083695803

Type

Individual (Type 1)

Primary specialty

Optometrist

Specialty group

Eye and Vision Services Providers

Taxonomy code

152W00000X

License number

T03134 (MO)

Sex

Male

Sole proprietor

No

Enumerated

2005-11-09

Last updated

2012-03-30