Provider Demographics
NPI:1932360914
Name:PRILUCK, JOSHUA (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
Last Name:PRILUCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10707 PACIFIC ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4762
Mailing Address - Country:US
Mailing Address - Phone:402-399-8055
Mailing Address - Fax:402-905-2448
Practice Address - Street 1:10707 PACIFIC ST
Practice Address - Street 2:SUITE 121
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4762
Practice Address - Country:US
Practice Address - Phone:402-399-8055
Practice Address - Fax:402-905-2448
Is Sole Proprietor?:No
Enumeration Date:2008-06-22
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.013147207W00000X
FLME109443207W00000X
NE27366207W00000X
IA41021207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology