Provider Demographics
NPI:1770583767
Name:PRATT, ADAM MATTHEW (OD)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:MATTHEW
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 1:1015 HIGHWAY 80
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-8111
Mailing Address - Country:US
Mailing Address - Phone:512-353-2141
Mailing Address - Fax:512-353-3774
Practice Address - Street 1:1015 HIGHWAY 80
Practice Address - Street 2:SUITE A
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-8111
Practice Address - Country:US
Practice Address - Phone:512-353-2141
Practice Address - Fax:512-353-3774
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-30
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05012T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX07341OtherSPECTERA
TX00E55VOtherBCBS
TX093089302Medicaid
TX093089302Medicaid