Provider Demographics
NPI:1588732705
Name:PRATT, ELISE COX (BCO)
Entity type:Individual
Prefix:MRS
First Name:ELISE
Middle Name:COX
Last Name:PRATT
Suffix:
Gender:F
Credentials:BCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 18TH ST S
Mailing Address - Street 2:SUITE #402
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1856
Mailing Address - Country:US
Mailing Address - Phone:205-939-1990
Mailing Address - Fax:
Practice Address - Street 1:700 18TH ST S
Practice Address - Street 2:SUITE #402
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1856
Practice Address - Country:US
Practice Address - Phone:205-939-1990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009918060Medicaid