Organization
OTIS OPTOMETRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATT DAVID WICKHAM O.D. (OWNER)
(314) 276-1228
Entity
Organization
Contact information
Practice address
94 CECIL ST, CAMDENTON, MO 65020-7057
(573) 317-9279
(888) 841-1312
Mailing address
1939 WENTZVILLE PKWY, STE 166, WENTZVILLE, MO 63385-3424
(636) 812-3821
(888) 841-1312
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TO3134
MO
Other
Enumeration date
05/12/2014
Last updated
07/29/2014
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