Healthcare Provider Details

I. General information

NPI: 1235156753
Provider Name (Legal Business Name): JULIEANN CAROL WICK OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 02/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 W DAKOTA PKWY
WILLISTON ND
58801-3807
US

IV. Provider business mailing address

PO BOX 5010
MINOT ND
58702-5010
US

V. Phone/Fax

Practice location:
  • Phone: 701-572-7641
  • Fax: 701-572-7710
Mailing address:
  • Phone: 701-857-5650
  • Fax: 701-857-5031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number728
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: