MEDICARE: DR. MONTGOMERY VICKERS OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	7885	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	410026174	OTHER	WV	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1021398	OTHER	WV	WORKERS COMPENSATION
2	4321742	OTHER	WV	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	000735441	OTHER	WA	BCBS

General Provider Information

NPI Number	:	1003958372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MONTGOMERY VICKERS OD

Provider Business Mailing Address
First Line	:	207 THORNBERRY DR
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75067-3776
Country	:	US
Telephone Number	:	304-549-8841
Fax Number	:

Provider Business Practice Location Address
First Line	:	690 S WATTERS RD
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75013-5008
Country	:	US
Telephone Number	:	972-727-6262
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	11/23/2019

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Directions to “ DR. MONTGOMERY VICKERS OD” Practice Location

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