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General NPI Number Information
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NPI Number | 1114045085
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Entity Type | Organization
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Legal Business Name | DAVID WICHNOSKI, O.D. , P.A.
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 06/13/2013
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Provider Practice Location Address
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Address Line | 7615 COLONY RD STE 105
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City | CHARLOTTE
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State | NC
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Zip | 28226
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Country | US
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Telephone | 704-543-9000
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Fax | 704-543-9002
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Provider Business Mailing Address
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Address Line | 7615 COLONY RD STE 105
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City | CHARLOTTE
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State | NC
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Zip | 28226
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Country | US
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Telephone | 704-543-9000
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Fax | 704-543-9002
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID JOSEPH WICHNOSKI
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Credential | OD
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Telephone | 704-543-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1632
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License Number State | NC
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