Healthcare Provider Details

I. General information

NPI: 1972782969
Provider Name (Legal Business Name): EMILY P PRATT OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 02/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 N ROXBORO ST
DURHAM NC
27704-2122
US

IV. Provider business mailing address

7020 SIX FORKS RD
RALEIGH NC
27615-6430
US

V. Phone/Fax

Practice location:
  • Phone: 919-595-2020
  • Fax: 919-226-3735
Mailing address:
  • Phone: 919-847-0187
  • Fax: 919-676-2231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2070
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: