Provider Demographics
NPI:1205983376
Name:DAVID M. PRITZKER O. D., P. C. .
Entity type:Organization
Organization Name:DAVID M. PRITZKER O. D., P. C. .
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:PRITZKER
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:717-751-6116
Mailing Address - Street 1:215 COUNTRY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:RED LION
Mailing Address - State:PA
Mailing Address - Zip Code:17356-8866
Mailing Address - Country:US
Mailing Address - Phone:717-751-6116
Mailing Address - Fax:717-751-0542
Practice Address - Street 1:215 COUNTRY RIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:RED LION
Practice Address - State:PA
Practice Address - Zip Code:17356-8866
Practice Address - Country:US
Practice Address - Phone:717-751-6116
Practice Address - Fax:717-751-0542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE005285T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT72481Medicare UPIN
PA048948Medicare ID - Type UnspecifiedLOCAL CARRIER IDENTIFIER