Provider Demographics
NPI:1669517959
Name:WRIGHT, MONTE E (O D)
Entity type:Individual
Prefix:
First Name:MONTE
Middle Name:E
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 NEW HOLT RD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-7455
Mailing Address - Country:US
Mailing Address - Phone:270-534-4510
Mailing Address - Fax:270-534-4560
Practice Address - Street 1:2408 NEW HOLT RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-7455
Practice Address - Country:US
Practice Address - Phone:270-534-4510
Practice Address - Fax:270-534-4560
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0847DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77000131Medicaid
KY77000131Medicaid
KYT54692Medicare UPIN
KY0488450001Medicare NSC