Provider Demographics
NPI:1568956605
Name:PRATT, KRISTEN (OD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:PRATT
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 1:801 KENWOOD LN
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-3416
Mailing Address - Country:US
Mailing Address - Phone:210-792-4185
Mailing Address - Fax:
Practice Address - Street 1:1506 JUDSON RD
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-3919
Practice Address - Country:US
Practice Address - Phone:903-758-8832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9414T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist