Provider Demographics
NPI:1225126006
Name:PRANGE, HAROLD T (OD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:T
Last Name:PRANGE
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:PO BOX 19386
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49019-0386
Mailing Address - Country:US
Mailing Address - Phone:269-372-1635
Mailing Address - Fax:
Practice Address - Street 1:6065 LITCHFIELD LN
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-9128
Practice Address - Country:US
Practice Address - Phone:269-372-1635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002270152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOC96504Medicare ID - Type Unspecified