Provider Demographics
NPI:1831231364
Name:EVANS, DAVID WRIGHT
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WRIGHT
Last Name:EVANS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOODSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:43793-1025
Mailing Address - Country:US
Mailing Address - Phone:740-472-0013
Mailing Address - Fax:
Practice Address - Street 1:232 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODSFIELD
Practice Address - State:OH
Practice Address - Zip Code:43793-1025
Practice Address - Country:US
Practice Address - Phone:740-472-0013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2877T1980152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0150018Medicaid
OH0150018Medicaid
OHT46204Medicare UPIN
OH0778950001Medicare NSC