Provider Demographics
NPI:1699764803
Name:WAINWRIGHT, BRENDA ANN (OD)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:ANN
Last Name:WAINWRIGHT
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 1:401 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-4767
Mailing Address - Country:US
Mailing Address - Phone:850-215-3937
Mailing Address - Fax:850-215-3937
Practice Address - Street 1:851 E 23RD ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-5311
Practice Address - Country:US
Practice Address - Phone:850-215-3937
Practice Address - Fax:850-215-3937
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC-3749152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL68166OtherBLUE CROSS BLUE SHIELD
FL203404651OtherTRICARE
FLU91653Medicare UPIN
FL203404651OtherTRICARE