Matthew David Wickham, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

T03134 Issued in MO

Practice address

3013 Winghaven Blvd
O Fallon, MO 63368-3600

Phone

(636) 561-3937

Fax

(636) 561-4068

NPI assigned

Nov 9, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Regional Eyecare Associates Inc

  • Optometrist
  • O'Fallon, MO
  • NPI 1043380652
  Medicare reassignment NPD
• Overland Optical, Inc

  dba Overland Optical Family Eye Care

  • Optician
  • Saint Charles, MO
  • NPI 1396833174
  NPD (past)
• Overland Optical, Inc.

  dba Overland Optical Family Eye Care

  • Optician
  • Saint Louis, MO
  • NPI 1457377848
  NPD (past)
• TLC Laser Eye Centers (Refractive I) Inc.

  dba TLC Laser Eye Centers St. Louis

  • Clinic/Center
  • Creve Coeur, MO
  • NPI 1447465703
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1131494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1333065600000",
    "number": "1083695803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3013 WINGHAVEN BLVD",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633683600",
            "telephone_number": "636-561-3937",
            "fax_number": "636-561-4068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3013 WINGHAVEN BLVD",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633683600",
            "telephone_number": "636-561-3937",
            "fax_number": "636-561-4068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKHAM",
        "first_name": "MATTHEW",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-09",
        "last_updated": "2012-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "T03134",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas George White Jr., D.D.S.
• Arron Whitt, LPC
• Moroline Whittington III, MSW LCSW
• Stephanie Whittington, BCBA, LBA
• Lela Wibbenmeyer, DC
• Robert D Wiele, MD
• Keith Thomas Wiethaupt
• Chandra K Wiewel, M.D.
• Kevin J Wilhite, PT
• Sarah Wille

• Optometrist in O'Fallon, MO
• Providers in O'Fallon, MO by specialty
• Optometrist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.