Provider Demographics
NPI:1366705527
Name:WRIGHT VISION CARE
Entity type:Organization
Organization Name:WRIGHT VISION CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETHA
Authorized Official - Middle Name:DELORES
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:404-579-4824
Mailing Address - Street 1:2070 N DECATUR RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5306
Mailing Address - Country:US
Mailing Address - Phone:404-636-6680
Mailing Address - Fax:404-636-1618
Practice Address - Street 1:2070 N DECATUR RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5306
Practice Address - Country:US
Practice Address - Phone:404-636-6680
Practice Address - Fax:404-636-1618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA1541152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA41ZCFXLMedicare PIN
GAU67681Medicare UPIN