Provider Demographics
NPI:1235156753
Name:WICK, JULIEANN CAROL (OD)
Entity type:Individual
Prefix:DR
First Name:JULIEANN
Middle Name:CAROL
Last Name:WICK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 5010
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58702-5010
Mailing Address - Country:US
Mailing Address - Phone:701-857-5650
Mailing Address - Fax:701-857-5031
Practice Address - Street 1:1321 W DAKOTA PKWY
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-3807
Practice Address - Country:US
Practice Address - Phone:701-572-7641
Practice Address - Fax:701-572-7710
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ND728152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND60757Medicaid
NDN720473Medicare PIN