Provider Demographics
NPI:1477752913
Name:PRUITT, JOSEPH ALLAN (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ALLAN
Last Name:PRUITT
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 1:26025 NEWPORT RD
Mailing Address - Street 2:STE. F #455
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584
Mailing Address - Country:US
Mailing Address - Phone:651-395-7585
Mailing Address - Fax:651-395-7585
Practice Address - Street 1:26025 NEWPORT RD
Practice Address - Street 2:STE. F #455
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584
Practice Address - Country:US
Practice Address - Phone:651-395-7585
Practice Address - Fax:651-395-7585
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-14
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002454152W00000X
CA13429152W00000X
OK3004152W00000X
FLTPOP155152W00000X
COOPT.0003894152W00000X
PAOEG004053152W00000X
MDTA2933152W00000X
KY2092152W00000X
MN3130152W00000X
TN2753152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty