Healthcare Provider Details

I. General information

NPI: 1346115383
Provider Name (Legal Business Name): DONALD WRIGHT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2025
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 VICTORIA DR
SANTA ROSA CA
95407-7847
US

IV. Provider business mailing address

2715 VICTORIA DR
SANTA ROSA CA
95407-7847
US

V. Phone/Fax

Practice location:
  • Phone: 707-526-9626
  • Fax:
Mailing address:
  • Phone: 707-526-9626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number5619
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: