Provider Demographics
NPI:1548386857
Name:WRIGHT, MARK (OD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
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 1:703 W COSHOCTON ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43031-9581
Mailing Address - Country:US
Mailing Address - Phone:740-967-2936
Mailing Address - Fax:740-967-1153
Practice Address - Street 1:703 W COSHOCTON ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:OH
Practice Address - Zip Code:43031-9581
Practice Address - Country:US
Practice Address - Phone:740-967-2936
Practice Address - Fax:740-967-1153
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3507-T1016152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0432955Medicaid
OHT47305Medicare UPIN
OH0498168Medicare PIN
OH0498161Medicare PIN
OH0432955Medicaid