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General NPI Number Information
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NPI Number | 1821376583
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Entity Type | Organization
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Legal Business Name | WICKS AND WICKS, P.A.
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Dates
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Enumeration Date | 07/29/2011
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Last Update Date | 07/29/2011
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Provider Practice Location Address
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Address Line | 15 EAST PLZ
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City | PARIS
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State | TX
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Zip | 75460-5841
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Country | US
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Telephone | 903-784-6649
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Fax | 903-784-6613
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Provider Business Mailing Address
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Address Line | 15 EAST PLZ
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City | PARIS
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State | TX
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Zip | 75460-5841
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Country | US
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Telephone | 903-784-6649
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Fax | 903-784-6613
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Authorized Official
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Title or Position | OWNER
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Name | DR. COLTON DALE WICKS
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Credential | O.D.
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Telephone | 903-784-6649
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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 | 7734T
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License Number State | TX
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