Individual
DR. MATTHEW DAVID WICKHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
3013 WINGHAVEN BLVD, O FALLON, MO 63368-3600
(636) 561-3937
(636) 561-4068
Mailing address
3013 WINGHAVEN BLVD, O FALLON, MO 63368-3600
(636) 561-3937
(636) 561-4068
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
T03134
MO
Other
Enumeration date
11/09/2005
Last updated
03/30/2012
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