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General NPI Number Information
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NPI Number | 1396867727
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Entity Type | Organization
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Legal Business Name | W.K.W. ENTERPRISES, P.C.
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Dates
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Enumeration Date | 04/05/2007
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Last Update Date | 04/18/2008
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Provider Practice Location Address
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Address Line | 2865 HOMER M ADAMS PKWY
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City | ALTON
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State | IL
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Zip | 62002-4856
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Country | US
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Telephone | 618-465-1654
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Fax | 618-465-8652
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Provider Business Mailing Address
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Address Line | 2865 HOMER M ADAMS PKWY
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City | ALTON
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State | IL
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Zip | 62002-4856
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Country | US
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Telephone | 618-465-1654
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Fax | 618-465-8652
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIAM KEVIN WRIGHT
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Credential | O.D.
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Telephone | 618-465-1654
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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 |
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License Number State | IL
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