Provider Demographics
NPI:1184910440
Name:PRATT, MURRAY S (OD)
Entity type:Individual
Prefix:
First Name:MURRAY
Middle Name:S
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 1:3961 E CHANDLER BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-0303
Mailing Address - Country:US
Mailing Address - Phone:480-706-3060
Mailing Address - Fax:
Practice Address - Street 1:3961 E CHANDLER BLVD STE 106
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-0303
Practice Address - Country:US
Practice Address - Phone:480-706-3060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1809152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3362111OtherUNITED HEALTH CARE
AZ1184910440OtherBC/BS
AZ3362111OtherUNITED HEALTH CARE