Individual
SHELBY G WICKHORST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1901 NE 162ND AVE STE D102, VANCOUVER, WA 98684-3010
(360) 944-1911
(360) 944-5255
Mailing address
1901 NE 162ND AVE STE D102, VANCOUVER, WA 98684-3010
(360) 944-1911
(360) 944-5255
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3526
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2027050
—
WA
Enumeration date
10/05/2006
Last updated
07/09/2007
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