Provider Demographics
NPI:1003871302
Name:WRIGHT, RICHARD THOMAS (OD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:THOMAS
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 1:1455 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-1837
Mailing Address - Country:US
Mailing Address - Phone:608-825-2020
Mailing Address - Fax:608-837-0414
Practice Address - Street 1:1455 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-1837
Practice Address - Country:US
Practice Address - Phone:608-825-2020
Practice Address - Fax:608-837-0414
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1519152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38505600Medicaid
WI38505600Medicaid
WI0465260001Medicare NSC
WIT63717Medicare UPIN