Provider Demographics
NPI:1114999893
Name:WRIGHT, TODD EARL (OD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:EARL
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 1:185 STONEBRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-4639
Mailing Address - Country:US
Mailing Address - Phone:405-359-8444
Mailing Address - Fax:405-285-8585
Practice Address - Street 1:185 STONEBRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-4639
Practice Address - Country:US
Practice Address - Phone:405-359-8444
Practice Address - Fax:405-285-8585
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2008-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1187152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T40726Medicare UPIN
OK1232360001Medicare NSC