NPI 1083695803

Matthew David Wickham, OD

Practitioner Optometrist O Fallon, MO

Practice location

Address: 3013 Winghaven Blvd, O Fallon, MO 63368-3600
Phone: (636) 561-3937
Fax: (636) 561-4068

Registered specialties

Optometrist Primary

Eye and Vision Services Providers Taxonomy 152W00000X Licence T03134 (MO)

Other Optometrist providers in Missouri →

Registry record

NPI: 1083695803
Entity type: Individual
Sex (as registered): Male
NPI issued: 9 Nov 2005
Record last updated: 30 Mar 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.