Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1225205602 |
---|---|
Provider Name | Mr. Willie Jake Wright II |
First Address | Arlington, TX 76015-4134 |
Second Address | Arlington, TX 76015-4134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2008 |
Last Update Date | 17/01/2022 |