Provider Demographics
NPI:1972593853
Name:PRASAD, SANTWANA (OD)
Entity Type:Individual
Prefix:
First Name:SANTWANA
Middle Name:
Last Name:PRASAD
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 1:300 STAFFORD ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-3581
Mailing Address - Country:US
Mailing Address - Phone:413-739-7367
Mailing Address - Fax:
Practice Address - Street 1:300 STAFFORD ST
Practice Address - Street 2:SUITE 212
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3581
Practice Address - Country:US
Practice Address - Phone:413-739-7367
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4370152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA33797OtherHEALTH NEW ENGLAND ID NO.
MA3875267OtherAETNA/USHEALTHCARE
MA467469OtherTUFTS ID NO.
MA0368977OtherCIGNA HEALTHCARE ID NO.
MAW16421OtherBLUE SHIELD OF MASS ID NO
CT043700OtherCONNECTICARE ID NO.
CTW16421OtherCT.BLUE SHIELD ID NO.
MA3875267OtherAETNA/USHEALTHCARE
MAW16421OtherBLUE SHIELD OF MASS ID NO