Provider Demographics
NPI:1891844106
Name:WRIGHT, JAMES B
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:B
Last Name:WRIGHT
Suffix:
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 1:125 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GAS CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46933-2061
Mailing Address - Country:US
Mailing Address - Phone:765-674-7781
Mailing Address - Fax:765-674-7782
Practice Address - Street 1:125 S 7TH ST
Practice Address - Street 2:
Practice Address - City:GAS CITY
Practice Address - State:IN
Practice Address - Zip Code:46933-2061
Practice Address - Country:US
Practice Address - Phone:765-674-7781
Practice Address - Fax:765-674-7782
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1460152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN900280070AMedicaid
IN0716660001Medicare NSC
IN0716660001Medicare PIN