Provider Demographics
NPI:1013355288
Name:AGRAWAL, PRARTHANA (OD)
Entity Type:Individual
Prefix:DR
First Name:PRARTHANA
Middle Name:
Last Name:AGRAWAL
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 1:5500 WISSAHICKON AVE
Mailing Address - Street 2:APT M111C
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-5653
Mailing Address - Country:US
Mailing Address - Phone:215-200-9536
Mailing Address - Fax:
Practice Address - Street 1:690 W DEKALB PIKE
Practice Address - Street 2:LENSCRAFTERS
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-2943
Practice Address - Country:US
Practice Address - Phone:610-337-4114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00695400152W00000X
TX10724T152W00000X
PAOEG002799152W00000X
WI3959-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist