Provider Demographics
NPI:1598040768
Name:HARRY G WRIGHT M.D. PC
Entity Type:Organization
Organization Name:HARRY G WRIGHT M.D. PC
Other - Org Name:SHIAWASSEE OPHTHALMOLOGY PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FRONT OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:M
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:ABO
Authorized Official - Phone:989-725-8158
Mailing Address - Street 1:259 N STATE RD
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-9075
Mailing Address - Country:US
Mailing Address - Phone:989-725-8125
Mailing Address - Fax:989-743-8111
Practice Address - Street 1:259 N STATE RD
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-9075
Practice Address - Country:US
Practice Address - Phone:989-725-8125
Practice Address - Fax:989-743-8111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-19
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIHW040772207W00000X
MI040772207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB42958Medicare UPIN
MIMI4992Medicare PIN