Provider Demographics
NPI:1164493730
Name:PRATER, CAREY G (OD)
Entity Type:Individual
Prefix:
First Name:CAREY
Middle Name:G
Last Name:PRATER
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 1:2440 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-3592
Mailing Address - Country:US
Mailing Address - Phone:903-595-0500
Mailing Address - Fax:903-595-2153
Practice Address - Street 1:2440 E 5TH ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-3592
Practice Address - Country:US
Practice Address - Phone:903-595-0500
Practice Address - Fax:903-595-2153
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02746TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80312QMedicare ID - Type Unspecified
TXT15355Medicare UPIN