Robert Vincent Wickes, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

1272 Issued in WA

Practice address

118 S Main St
Montesano, WA 98563-3709

Phone

(360) 249-3485

Fax

(360) 249-2747

NPI assigned

Oct 12, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

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

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.

• Montesano Vision Center PLLC

  • Optometrist
  • Montesano, WA
  • NPI 1104112358
  NPD (past)

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1198022400000",
    "number": "1215026489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 S MAIN ST",
            "city": "MONTESANO",
            "state": "WA",
            "postal_code": "985633709",
            "telephone_number": "360-249-3485",
            "fax_number": "360-249-2747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 S MAIN ST",
            "city": "MONTESANO",
            "state": "WA",
            "postal_code": "985633709",
            "telephone_number": "360-249-3485",
            "fax_number": "360-249-2747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKES",
        "first_name": "ROBERT",
        "middle_name": "VINCENT",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2007-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "1272",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2012995",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lynn Marie Wakeman
• Christine Yvonne Walters, SLPA
• Brittany Renee Weaver, MA61404816
• Kyna Weidman Wilson, D.C.
• Sean Rae White, M.D.
• Geoffrey Forrest Wills, O.D.

• Optometrist in Montesano, WA
• Providers in Montesano, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2007; 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.