Healthcare Provider Details

I. General information

NPI: 1285818617
Provider Name (Legal Business Name): ELIZABETH PRADHAN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 LARK DR
ALBANY NY
12207-1398
US

IV. Provider business mailing address

920 LARK DR
ALBANY NY
12207-1398
US

V. Phone/Fax

Practice location:
  • Phone: 518-465-4771
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV005346
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: