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Individual

DR. AUTUMN KAY WICKE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
O.D.

Contact information

Practice address
1555 BRADY ROAD, CHESANING, MI 48616-0355
(989) 845-7050
(989) 845-2036
Mailing address
1555 BRADY ROAD, CHESANING, MI 48616-0355
(989) 845-7050
(989) 845-2036

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901004333
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
944824022
MI
Enumeration date
03/15/2006
Last updated
07/02/2009
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