DR. Matthew David Wickham, OD

NPI #1083695803 in O Fallon, Missouri

Provider Information

NPI Number: 1083695803
Entity Type: Individual
Name: DR. Matthew David Wickham, OD
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Optometrist
Credential: OD
Enumeration Date: Nov 9, 2005
Last Updated: Mar 30, 2012

Practice Location

Address: 3013 WINGHAVEN BLVD
City: O Fallon
State: Missouri
ZIP Code: 63368-3600
Phone: (636) 561-3937

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Optometrist	152W00000X	Primary

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