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General NPI Number Information
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NPI Number | 1366705527
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Entity Type | Organization
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Legal Business Name | WRIGHT VISION CARE
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Dates
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Enumeration Date | 06/21/2012
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Last Update Date | 06/21/2012
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Provider Practice Location Address
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Address Line | 2070 N DECATUR RD
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City | DECATUR
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State | GA
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Zip | 30033-5306
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Country | US
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Telephone | 404-636-6680
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Fax | 404-636-1618
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Provider Business Mailing Address
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Address Line | 2070 N DECATUR RD
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City | DECATUR
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State | GA
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Zip | 30033-5306
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Country | US
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Telephone | 404-636-6680
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Fax | 404-636-1618
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Authorized Official
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Title or Position | OWNER
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Name | DR. KENNETHA DELORES WRIGHT
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Credential | O.D.
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Telephone | 404-579-4824
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | GA1541
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License Number State | GA
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