Healthcare Provider Details

I. General information

NPI: 1487994802
Provider Name (Legal Business Name): JAMES A PRATE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2013
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 CHEWS LANDING RD
LAUREL SPRINGS NJ
08021-2769
US

IV. Provider business mailing address

1405 CHEWS LANDING RD
LAUREL SPRINGS NJ
08021-2769
US

V. Phone/Fax

Practice location:
  • Phone: 856-228-1171
  • Fax: 856-225-1545
Mailing address:
  • Phone: 856-228-1171
  • Fax: 856-225-1545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number27OM00065300
License Number StateNJ

VIII. Authorized Official

Name: JAMES A PRATE JR.
Title or Position: OPTOMETRIST
Credential: O. D.
Phone: 856-228-1171