Provider Demographics
NPI:1831549146
Name:PRATIK VYAS OD LLC
Entity type:Organization
Organization Name:PRATIK VYAS OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRATIK
Authorized Official - Middle Name:
Authorized Official - Last Name:VYAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:562-650-0415
Mailing Address - Street 1:3 DUTCH VLG
Mailing Address - Street 2:APT #BR
Mailing Address - City:MENANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12204-2905
Mailing Address - Country:US
Mailing Address - Phone:562-650-0415
Mailing Address - Fax:
Practice Address - Street 1:3 DUTCH VLG
Practice Address - Street 2:APT #BR
Practice Address - City:MENANDS
Practice Address - State:NY
Practice Address - Zip Code:12204-2905
Practice Address - Country:US
Practice Address - Phone:562-650-0415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT008390152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty