Provider Demographics
NPI:1013253418
Name:DAVID WICHNOKSI OD PA
Entity Type:Organization
Organization Name:DAVID WICHNOKSI OD PA
Other - Org Name:SPECTRUM EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:WICHNOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:704-543-9000
Mailing Address - Street 1:7615 COLONY RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-5017
Mailing Address - Country:US
Mailing Address - Phone:704-543-9000
Mailing Address - Fax:704-543-9002
Practice Address - Street 1:200 S COLLEGE ST STE 307
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-2065
Practice Address - Country:US
Practice Address - Phone:704-334-4444
Practice Address - Fax:704-334-4441
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVID WICHNOSKI OD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1632152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty