Provider Demographics
NPI:1073661187
Name:PRATT, THOMAS GEORGE (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GEORGE
Last Name:PRATT
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 1:101 TOWER ROAD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5098
Mailing Address - Country:US
Mailing Address - Phone:605-217-4500
Mailing Address - Fax:605-217-4503
Practice Address - Street 1:101 TOWER RD
Practice Address - Street 2:SUITE 300
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049-5007
Practice Address - Country:US
Practice Address - Phone:605-217-4500
Practice Address - Fax:605-217-4503
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD650152W00000X
IA1840152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA23081Medicare PIN
SDS102389Medicare PIN