Provider Demographics
NPI:1124012745
Name:WRIGHT, CHRISTOPHER MICHAEL (OD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MICHAEL
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 1:534 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-3214
Mailing Address - Country:US
Mailing Address - Phone:760-352-4361
Mailing Address - Fax:760-352-4634
Practice Address - Street 1:534 S 8TH ST
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-3214
Practice Address - Country:US
Practice Address - Phone:760-352-4361
Practice Address - Fax:760-352-4634
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9558T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U02822Medicare UPIN
OP9558Medicare ID - Type Unspecified
CA1276370001Medicare NSC