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General NPI Number Information
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NPI Number | 1750430567
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Entity Type | Organization
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Legal Business Name | J LARRY PRITCHETT O D P C
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 01/21/2010
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Provider Practice Location Address
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Address Line | 162 E BROAD ST
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City | CAMILLA
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State | GA
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Zip | 31730-1841
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Country | US
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Telephone | 229-336-8991
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Fax | 229-336-0141
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Provider Business Mailing Address
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Address Line | 279 PEARSON DR SW
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City | DAWSON
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State | GA
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Zip | 39842-1914
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Country | US
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Telephone | 229-995-2920
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Fax | 229-995-5034
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Authorized Official
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Title or Position | CEO
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Name | JAMES LARRY PRITCHETT
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Credential | O.D.
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Telephone | 229-995-2920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | OPT000689
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT000689
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License Number State | GA
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