Provider Demographics
NPI:1720051568
Name:PRONTI, PAUL MICHAEL
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MICHAEL
Last Name:PRONTI
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:PAUL
Other - Middle Name:M
Other - Last Name:PRONTI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:280 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-1801
Mailing Address - Country:US
Mailing Address - Phone:716-854-1621
Mailing Address - Fax:716-854-1623
Practice Address - Street 1:280 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-1801
Practice Address - Country:US
Practice Address - Phone:716-854-1621
Practice Address - Fax:716-854-1623
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0047371152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMDG6673OtherRAILROAD MEDICARE GROUP
NY410024327OtherRAILROAD MEDICARE PTAN
NY45535Medicare ID - Type Unspecified