Provider Demographics
NPI:1457314320
Name:WRIGHT, JULIE ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ANN
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 1:1891 GA HIGHWAY 40 E
Mailing Address - Street 2:SUITE 1108
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-6527
Mailing Address - Country:US
Mailing Address - Phone:912-576-8980
Mailing Address - Fax:912-576-8842
Practice Address - Street 1:1891 GA HIGHWAY 40 E
Practice Address - Street 2:SUITE 1108
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-6527
Practice Address - Country:US
Practice Address - Phone:912-576-8980
Practice Address - Fax:912-576-8842
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001626152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00765047BMedicaid
GADG7793OtherRAILROAD MEDICARE GROUP #
GA410049677OtherRAILROAD MEDICARE PTAN
GA41ZCFGFOtherMEDICARE PTAN
GADG7793OtherRAILROAD MEDICARE GROUP #
U67680Medicare UPIN
GA41ZCFGFOtherMEDICARE PTAN