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Individual

ROBERT VINCENT WICKES

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
118 S MAIN ST, MONTESANO, WA 98563-3709
(360) 249-3485
(360) 249-2747
Mailing address
118 S MAIN ST, MONTESANO, WA 98563-3709
(360) 249-3485
(360) 249-2747

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1272
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2012995
WA
Enumeration date
10/12/2006
Last updated
12/19/2007
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