Provider Demographics
NPI:1215074943
Name:WRIGHT, PHILLIP R (OD)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:R
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:401 S INDIANA ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:MOORESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46158-2798
Mailing Address - Country:US
Mailing Address - Phone:317-831-4071
Mailing Address - Fax:317-831-4489
Practice Address - Street 1:401 S INDIANA ST
Practice Address - Street 2:SUITE C
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-2798
Practice Address - Country:US
Practice Address - Phone:317-831-4071
Practice Address - Fax:317-831-4489
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001762A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN561530Medicare PIN
IN0204720001Medicare NSC