Healthcare Provider Details

I. General information

NPI: 1972593853
Provider Name (Legal Business Name): SANTWANA PRASAD O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 STAFFORD ST SUITE 212
SPRINGFIELD MA
01104-3581
US

IV. Provider business mailing address

300 STAFFORD ST SUITE 212
SPRINGFIELD MA
01104-3581
US

V. Phone/Fax

Practice location:
  • Phone: 413-739-7367
  • Fax:
Mailing address:
  • Phone: 413-739-7367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number4370
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier33797
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerHEALTH NEW ENGLAND ID NO.
# 2
Identifier3875267
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerAETNA/USHEALTHCARE
# 3
Identifier467469
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerTUFTS ID NO.
# 4
Identifier0368977
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerCIGNA HEALTHCARE ID NO.
# 5
IdentifierW16421
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerBLUE SHIELD OF MASS ID NO
# 6
Identifier043700
Identifier TypeOTHER
Identifier StateCT
Identifier IssuerCONNECTICARE ID NO.
# 7
IdentifierW16421
Identifier TypeOTHER
Identifier StateCT
Identifier IssuerCT.BLUE SHIELD ID NO.

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: