Provider Demographics
NPI:1578876447
Name:PRADO, EFREM JONATHAN (OD)
Entity Type:Individual
Prefix:DR
First Name:EFREM
Middle Name:JONATHAN
Last Name:PRADO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3625 MIDWAY DR
Mailing Address - Street 2:STE P
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-5253
Mailing Address - Country:US
Mailing Address - Phone:510-461-3931
Mailing Address - Fax:
Practice Address - Street 1:3625 MIDWAY DR
Practice Address - Street 2:STE P
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-5253
Practice Address - Country:US
Practice Address - Phone:619-223-3028
Practice Address - Fax:619-223-3042
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA942991598152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist