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Individual
DR. MONTGOMERY VICKERS
Active
Individual
DR. MONTGOMERY VICKERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
7885
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000735441
BCBS
WA
05
—
0150620000
—
WV
01
—
1021398
WORKERS COMPENSATION
WV
01
—
410026174
RAILROAD MEDICARE
WV
01
—
4321742
AETNA
WV
Enumeration date
02/13/2007
Last updated
11/23/2019
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