Healthcare Provider Details

I. General information

NPI: 1932184553
Provider Name (Legal Business Name): JEAN A. WRIGHTNOUR O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 10/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 W PROSPECT RD SUITE B
ASHTABULA OH
44004-5864
US

IV. Provider business mailing address

517 W PROSPECT RD SUITE B
ASHTABULA OH
44004-5864
US

V. Phone/Fax

Practice location:
  • Phone: 440-992-9416
  • Fax: 440-992-4987
Mailing address:
  • Phone: 440-992-9416
  • Fax: 440-992-4987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4064/T709
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number4064/T709
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number4064/T709
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: