Provider Demographics
NPI:1740496249
Name:PTAK, FRANK (OD)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:PTAK
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 1:2418 N HUNTER PLACE LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-4606
Mailing Address - Country:US
Mailing Address - Phone:817-461-6130
Mailing Address - Fax:
Practice Address - Street 1:2418 N HUNTER PLACE LN
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-4606
Practice Address - Country:US
Practice Address - Phone:817-461-6130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2747TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT15387Medicare UPIN