Provider Demographics
NPI:1821289992
Name:JEAN A. WRIGHTNOUR, O.D. INC.
Entity Type:Organization
Organization Name:JEAN A. WRIGHTNOUR, O.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:WRIGHTNOUR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:440-992-9416
Mailing Address - Street 1:517 W PROSPECT RD STE B
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-5864
Mailing Address - Country:US
Mailing Address - Phone:440-992-9416
Mailing Address - Fax:
Practice Address - Street 1:517 W PROSPECT RD STE B
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-5864
Practice Address - Country:US
Practice Address - Phone:440-992-9416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4064/T709152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0714614Medicaid
OH0714614Medicaid
OH0458740001Medicare NSC
OH0619451Medicare PIN