Basic Information
| Provider Information | |||||||||
| NPI: | 1861471914 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COURTRIGHT | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3153 N WINDSONG DR | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT VALLEY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863142240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287719939 | ||||||||
| FaxNumber: | 9287723972 | ||||||||
| Practice Location | |||||||||
| Address1: | 3153 N WINDSONG DR | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT VALLEY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863142240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287719939 | ||||||||
| FaxNumber: | 9287723972 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2006 | ||||||||
| LastUpdateDate: | 03/30/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 909 | AZ | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 410049678 | 01 | AZ | RAILROAD MEDICARE # | OTHER | 24871 | 01 | AZ | AVESIS NUMBER | OTHER | 757768 | 05 | AZ | MEDICAID | 4844460001 | 01 | AZ | MEDICARE DMERC | OTHER | AZ0903430 | 01 | AZ | BCBS UMBER | OTHER |