Provider Demographics
NPI:1861471914
Name:COURTRIGHT, BRIAN JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JOHN
Last Name:COURTRIGHT
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 1:3153 N WINDSONG DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-2240
Mailing Address - Country:US
Mailing Address - Phone:928-771-9939
Mailing Address - Fax:928-772-3972
Practice Address - Street 1:3153 N WINDSONG DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2240
Practice Address - Country:US
Practice Address - Phone:928-771-9939
Practice Address - Fax:928-772-3972
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ909152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ410049678OtherRAILROAD MEDICARE #
AZ24871OtherAVESIS NUMBER
AZ757768Medicaid
AZ4844460001OtherMEDICARE DMERC
AZAZ0903430OtherBCBS UMBER
AZ4844460001OtherMEDICARE DMERC
AZ757768Medicaid