Provider Demographics
NPI:1508691791
Name:PRUITT OPTOMETRIC EYE CARE LTD
Entity type:Organization
Organization Name:PRUITT OPTOMETRIC EYE CARE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUITT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:651-395-7585
Mailing Address - Street 1:26025 NEWPORT RD.
Mailing Address - Street 2:STE. F #455
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-7309
Mailing Address - Country:US
Mailing Address - Phone:651-395-7585
Mailing Address - Fax:
Practice Address - Street 1:26025 NEWPORT RD.
Practice Address - Street 2:STE. F #455
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-7309
Practice Address - Country:US
Practice Address - Phone:651-395-7585
Practice Address - Fax:651-395-7585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty