Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1519 | WI |
NPI | 1003871302 |
---|---|
Provider Name | Richard Thomas Wright |
First Address | Sun Prairie, WI 53590-1837 |
Second Address | Sun Prairie, WI 53590-1837 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 28/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
38505600 | (05) | WI |
T63717 | (02) | WI |