Provider Demographics
NPI:1780925503
Name:PRATT OPHTHALMOLOGY ASSOCIATES, INC.
Entity type:Organization
Organization Name:PRATT OPHTHALMOLOGY ASSOCIATES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-636-5000
Mailing Address - Street 1:800 WASHINGTON ST
Mailing Address - Street 2:BOX1013
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1552
Mailing Address - Country:US
Mailing Address - Phone:617-636-5000
Mailing Address - Fax:
Practice Address - Street 1:300 MOUNT AUBURN STREET
Practice Address - Street 2:SUITE 414
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138
Practice Address - Country:US
Practice Address - Phone:617-636-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRATT OPHTHALMOLOGY ASSOCIATES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-04
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty