Provider Demographics
NPI:1477986651
Name:PRATT EYE CARE LLC
Entity Type:Organization
Organization Name:PRATT EYE CARE LLC
Other - Org Name:PRATT 20/20 EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:417-678-2161
Mailing Address - Street 1:PO BOX 676
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:MO
Mailing Address - Zip Code:65605-0676
Mailing Address - Country:US
Mailing Address - Phone:417-678-2161
Mailing Address - Fax:417-678-2241
Practice Address - Street 1:930 S ELLIOTT AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:MO
Practice Address - Zip Code:65605-2402
Practice Address - Country:US
Practice Address - Phone:417-678-2161
Practice Address - Fax:417-678-2241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-12
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02302152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO310574918Medicaid
MO6835510001Medicare NSC
MOMA4579Medicare UPIN