Provider Demographics
NPI:1669814000
Name:WRIGHT, TOMMIE LEE JR
Entity Type:Individual
Prefix:MR
First Name:TOMMIE
Middle Name:LEE
Last Name:WRIGHT
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 E WINSTON DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-8066
Mailing Address - Country:US
Mailing Address - Phone:602-705-6501
Mailing Address - Fax:
Practice Address - Street 1:1602 E WINSTON DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-8066
Practice Address - Country:US
Practice Address - Phone:602-705-6501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZITIN152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist