Provider Demographics
NPI:1922167022
Name:WRIGHT, SUSAN J (OD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:JOAN
Other - Last Name:JAMGOCHIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3349 REED POINT DR
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-1557
Mailing Address - Country:US
Mailing Address - Phone:614-876-5872
Mailing Address - Fax:
Practice Address - Street 1:6285 EMERALD PARKWAY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-3241
Practice Address - Country:US
Practice Address - Phone:614-764-8956
Practice Address - Fax:614-764-9532
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4502152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U46720Medicare UPIN
OHWR0753765Medicare PIN