Provider Demographics
NPI:1447452495
Name:WRIGHT, SERGE W (OD)
Entity type:Individual
Prefix:
First Name:SERGE
Middle Name:W
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 SOLDIERS PASS RD
Mailing Address - Street 2:SUITE A1
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-4781
Mailing Address - Country:US
Mailing Address - Phone:928-282-4126
Mailing Address - Fax:928-282-5762
Practice Address - Street 1:95 SOLDIERS PASS RD
Practice Address - Street 2:SUITE A1
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-4781
Practice Address - Country:US
Practice Address - Phone:928-282-4126
Practice Address - Fax:928-282-5762
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ262152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1114964939OtherSEDONA EYE CARE, P.C NPI
AZ4526786OtherAENTA
AZAZ0171820OtherBLUE CROSS BLUE SHIELD
AZT76958Medicare UPIN
AZZWCKNPMedicare ID - Type Unspecified