Provider Demographics
NPI:1396811154
Name:WRIGHT, JAMES CLIFFORD (OD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:CLIFFORD
Last Name:WRIGHT
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 1:172 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2846
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15251 E 14TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-1905
Practice Address - Country:US
Practice Address - Phone:510-481-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7097T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7097TOtherCA STATE OPTOMETRY LICENS
U35501Medicare UPIN