Provider Demographics
NPI:1992155196
Name:VYAS, PRATIK (OD)
Entity type:Individual
Prefix:MR
First Name:PRATIK
Middle Name:
Last Name:VYAS
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 1:3 DUTCH VLG
Mailing Address - Street 2: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: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:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT008390152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist