Healthcare Provider Details

I. General information

NPI: 1649754748
Provider Name (Legal Business Name): JUSTIN JEFFRY WRIGHT OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2018
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 MARKET ST FL 10
SAN FRANCISCO CA
94103-1540
US

IV. Provider business mailing address

806 HUNTINGDON PL
AUSTIN TX
78745-5508
US

V. Phone/Fax

Practice location:
  • Phone: 415-818-1155
  • Fax:
Mailing address:
  • Phone: 480-227-3897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number35898TLG
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number9578T
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: