Provider Demographics
NPI:1730184508
Name:WRIGHT, TYLER JOSEPH (OD)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:JOSEPH
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 1:859 ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:MANHEIM
Mailing Address - State:PA
Mailing Address - Zip Code:17545-9278
Mailing Address - Country:US
Mailing Address - Phone:717-665-1311
Mailing Address - Fax:
Practice Address - Street 1:3201 PAXTON ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-1340
Practice Address - Country:US
Practice Address - Phone:717-561-6000
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001486152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA085488SYPMedicare ID - Type UnspecifiedMEDICARE PROVIDER