Provider Demographics
NPI:1063531648
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:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-338-9595
Mailing Address - Street 1:800 WASHINGTON ST
Mailing Address - Street 2:BOX 450
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1552
Mailing Address - Country:US
Mailing Address - Phone:617-338-9595
Mailing Address - Fax:616-636-1264
Practice Address - Street 1:11 NEVINS ST
Practice Address - Street 2:ST ELIZABETH'S MEDICAL BLDG. SUITE 205
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3514
Practice Address - Country:US
Practice Address - Phone:617-779-7330
Practice Address - Fax:617-783-0734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3099156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5640980002Medicare NSC