Provider Demographics
NPI:1215087556
Name:PRATT, BRIAN ANDREW (OD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:ANDREW
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 1:274 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-1157
Mailing Address - Country:US
Mailing Address - Phone:585-727-7321
Mailing Address - Fax:585-425-2818
Practice Address - Street 1:274 W MAIN ST
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-1157
Practice Address - Country:US
Practice Address - Phone:585-924-4430
Practice Address - Fax:585-924-4093
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY6465152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC8829Medicare ID - Type Unspecified
NYU90106Medicare UPIN