Provider Demographics
NPI:1700093085
Name:MARTHA WRIGHT OD LLC
Entity Type:Organization
Organization Name:MARTHA WRIGHT OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:251-955-3939
Mailing Address - Street 1:7685 STATE HIGHWAY 59
Mailing Address - Street 2:SUITE A
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535
Mailing Address - Country:US
Mailing Address - Phone:251-955-3939
Mailing Address - Fax:251-955-3940
Practice Address - Street 1:7685 STATE HIGHWAY 59
Practice Address - Street 2:SUITE A
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535
Practice Address - Country:US
Practice Address - Phone:251-955-3939
Practice Address - Fax:251-955-3940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS648TA377152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51540012OtherBLUE CROSS BLUE SHIELD
AL51540012OtherBLUE CROSS BLUE SHIELD
ALL180Medicare PIN