Organization
DONNA R WIKE, O.D., P.A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONNA R WIKE (DOCTOR/PRESIDENT)
(704) 873-1423
Entity
Organization
Contact information
Practice address
1721 C EAST BROAD ST., STATESVILLE, NC 28625-4345
(704) 873-1423
(704) 873-1424
Mailing address
1721 C EAST BROAD ST., STATESVILLE, NC 28625-4345
(704) 873-1423
(704) 873-1424
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
929
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8909978
—
NC
Enumeration date
10/20/2010
Last updated
10/20/2010
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