Provider Demographics
NPI:1710076658
Name:WRIGHT, SCOTT MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:MICHAEL
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 1:1344 W ARROWHEAD RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-2218
Mailing Address - Country:US
Mailing Address - Phone:715-392-6222
Mailing Address - Fax:715-392-6220
Practice Address - Street 1:1344 W ARROWHEAD RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-2218
Practice Address - Country:US
Practice Address - Phone:715-392-6222
Practice Address - Fax:715-392-6220
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2844152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN164327OtherUCARE
MN522433100Medicaid
MN586G1WROtherBLUE CROSS BLUE SHEILD
MN22-03410OtherMEDICA
MN647281034058OtherPREFFERED ONE
U93141Medicare UPIN