Provider Demographics
NPI:1699810804
Name:PRATT, JOHN W (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:W
Last Name:PRATT
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1240 COLONIAL COMMONS CT
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-2200
Mailing Address - Country:US
Mailing Address - Phone:803-285-3333
Mailing Address - Fax:803-286-1797
Practice Address - Street 1:1240 COLONIAL COMMONS CT
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-2200
Practice Address - Country:US
Practice Address - Phone:803-285-3333
Practice Address - Fax:803-286-1797
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC696156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDV6967Medicaid