Provider Demographics
NPI:1528136975
Name:WICKIZER, DAWN E (OD)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:E
Last Name:WICKIZER
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 1:436 S RANDALL RD
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-9723
Mailing Address - Country:US
Mailing Address - Phone:847-658-4242
Mailing Address - Fax:847-658-5643
Practice Address - Street 1:436 S RANDALL RD
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-9723
Practice Address - Country:US
Practice Address - Phone:847-658-4242
Practice Address - Fax:847-658-5643
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management