Provider Demographics
NPI:1962652784
Name:WRIGHT FAMILY VISION LLC
Entity Type:Organization
Organization Name:WRIGHT FAMILY VISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:601-922-9272
Mailing Address - Street 1:4253 ROBINSON ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39209-6530
Mailing Address - Country:US
Mailing Address - Phone:601-922-9272
Mailing Address - Fax:601-922-8252
Practice Address - Street 1:4253 ROBINSON ST
Practice Address - Street 2:SUITE 105
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39209-6530
Practice Address - Country:US
Practice Address - Phone:601-922-9272
Practice Address - Fax:601-922-8252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS493152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00087912Medicaid
MST21194Medicare UPIN
MS00087912Medicaid