Provider Demographics
NPI:1598940777
Name:PRATT, COREY D (OD)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:D
Last Name:PRATT
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 1:3826 JEFFERSON DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-4835
Mailing Address - Country:US
Mailing Address - Phone:714-930-6769
Mailing Address - Fax:
Practice Address - Street 1:3485 W 10TH ST STE C
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-5368
Practice Address - Country:US
Practice Address - Phone:970-353-4746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT-2617152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist