Healthcare Provider Details

I. General information

NPI: 1366894982
Provider Name (Legal Business Name): PRAVAK & ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 OSTRUM ST STE 100
FOUNTAIN HILL PA
18015-1010
US

IV. Provider business mailing address

800 OSTRUM ST STE 100
FOUNTAIN HILL PA
18015-1010
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-3010
  • Fax: 484-526-3591
Mailing address:
  • Phone: 484-526-3010
  • Fax: 484-526-3591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number StatePA

VIII. Authorized Official

Name: DR. ROMAN OREST PRAVAK
Title or Position: AUTHORIZED REP/OWNER
Credential: M.D.
Phone: 484-526-3010