Provider Demographics
NPI:1235288267
Name:PRASAD, NIROPA (OD)
Entity Type:Individual
Prefix:DR
First Name:NIROPA
Middle Name:
Last Name:PRASAD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3402 13TH AVE S
Mailing Address - Street 2:SUITE D
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103
Mailing Address - Country:US
Mailing Address - Phone:701-234-0939
Mailing Address - Fax:701-234-9442
Practice Address - Street 1:3402 13TH AVE S
Practice Address - Street 2:SUITE D
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103
Practice Address - Country:US
Practice Address - Phone:701-234-0939
Practice Address - Fax:701-234-9442
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND484152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND14202OtherBLUE SHIELD OF ND PIN
MN5C646PROtherBLUE SHIELD OF MN PIN
ND14202OtherBLUE SHIELD OF ND PIN
MN5C646PROtherBLUE SHIELD OF MN PIN