Provider Demographics
NPI:1255477097
Name:WRIGHT, DAWN ELLEN (OD)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:ELLEN
Last Name:WRIGHT
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 S INDIANA ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:MOORESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46158-2798
Mailing Address - Country:US
Mailing Address - Phone:317-831-4071
Mailing Address - Fax:317-831-4489
Practice Address - Street 1:401 S INDIANA ST
Practice Address - Street 2:SUITE C
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-2798
Practice Address - Country:US
Practice Address - Phone:317-831-4071
Practice Address - Fax:317-831-4489
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001817A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0204720001Medicare NSC
IN561610Medicare PIN