Provider Demographics
NPI:1669650644
Name:PHILLIP G. WRIGHT, OPTOMETRIST, LTD
Entity Type:Organization
Organization Name:PHILLIP G. WRIGHT, OPTOMETRIST, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:401-521-5500
Mailing Address - Street 1:740 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-5702
Mailing Address - Country:US
Mailing Address - Phone:401-521-5500
Mailing Address - Fax:401-272-8284
Practice Address - Street 1:740 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5702
Practice Address - Country:US
Practice Address - Phone:401-521-5500
Practice Address - Fax:401-272-8284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTA00349152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty