Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 095855 | IA |
NPI | 1003460734 |
---|---|
Provider Name | Dr. Morgan Elizabeth Wichman |
First Address | Des Moines, IA 50309 |
Second Address | Ankeny, IA 50021-3935 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2019 |
Last Update Date | 31/07/2019 |