Provider Demographics
NPI:1811084403
Name:WRIGHT, PHILLIP G (OD)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:G
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 TOLLGATE ROAD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-0444
Mailing Address - Country:US
Mailing Address - Phone:401-738-5500
Mailing Address - Fax:401-738-5505
Practice Address - Street 1:200 TOLLGATE ROAD
Practice Address - Street 2:SUITE 202
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-0444
Practice Address - Country:US
Practice Address - Phone:401-738-5500
Practice Address - Fax:401-738-5505
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODT00349152W00000X
RIODTA00349152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIPW04786Medicaid
RIPW04786Medicaid
ID050509533Medicare UPIN
419007917Medicare PIN