Individual
DR. C. GREGORY VICKERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
9815 HWY 70 WEST, SUITE 102, MINOCQUA, WI 54548-0971
(715) 358-3937
(715) 358-7677
Mailing address
PO BOX 971, MINOCQUA, WI 54548-0971
(715) 358-3937
(715) 358-7677
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2838-035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38621700
—
WI
Enumeration date
07/05/2006
Last updated
07/08/2007
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