Provider Demographics
NPI:1003460734
Name:WICHMAN, MORGAN ELIZABETH (OD)
Entity Type:Individual
Prefix:DR
First Name:MORGAN
Middle Name:ELIZABETH
Last Name:WICHMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 10TH ST
Mailing Address - Street 2:UNIT 508
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309
Mailing Address - Country:US
Mailing Address - Phone:815-238-9272
Mailing Address - Fax:
Practice Address - Street 1:1805 SE DELAWARE AVE STE 900
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-3935
Practice Address - Country:US
Practice Address - Phone:515-333-5845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA095855152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist