Matthew David Wickham, OD

Optometrist · O Fallon, MO

Individual Active NPI

NPI number 1083695803

Practice location

3013 Winghaven Blvd
O Fallon, MO 63368-3600
Phone
(636) 561-3937
Fax
(636) 561-4068

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NPI record

NPI
1083695803
Entity type
Individual (Type 1)
Enumeration date
November 9, 2005
Last updated
March 30, 2012
Sole proprietor
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Optometrist Primary 152W00000X T03134 MO

About Dr. Wickham

Matthew David Wickham, OD is a healthcare provider registered in the NPI registry with the primary taxonomy Optometrist (code 152W00000X). The practice location is 3013 Winghaven Blvd, O Fallon, MO 63368-3600. The NPI number 1083695803 was assigned on November 9, 2005 and the record was last updated on March 30, 2012.

Dr. Wickham lists a license in the registry: #T03134 (MO) for Optometrist. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Matthew David Wickham, OD?

The NPI number is 1083695803.

What is the phone number of Dr. Wickham?

The phone number listed for the practice location is (636) 561-3937.

Where is Dr. Wickham located?

3013 Winghaven Blvd, O Fallon, MO 63368-3600.

What is the taxonomy code for Dr. Wickham?

The primary taxonomy code is 152W00000X – Optometrist.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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