Provider Demographics
NPI:1699826404
Name:PRIJATEL, LOUIS STEPHEN (OD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:STEPHEN
Last Name:PRIJATEL
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 1:330 INLAND SHOPPING CENTER
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408
Mailing Address - Country:US
Mailing Address - Phone:909-885-6193
Mailing Address - Fax:909-884-3015
Practice Address - Street 1:330 INLAND SHOPPING CTR.
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-1931
Practice Address - Country:US
Practice Address - Phone:909-381-7661
Practice Address - Fax:909-884-3015
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5199T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT69993Medicare UPIN
CASD0051990Medicare ID - Type Unspecified