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General NPI Number Information
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NPI Number | 1831209311
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Entity Type | Individual
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Provider Name | ALAN RICHARD PRADILLO O.D.
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Gender | Male
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 12/08/2022
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Provider Practice Location Address
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Address Line | 1501 DEREK DR
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City | HAMMOND
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State | LA
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Zip | 70403-5745
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Country | US
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Telephone | 985-345-0607
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Fax | 985-345-0490
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Provider Business Mailing Address
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Address Line | 110 W ROBERT ST
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City | HAMMOND
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State | LA
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Zip | 70401-3227
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Country | US
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Telephone | 985-345-0607
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Fax | 985-345-0490
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1534565T
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License Number State | LA
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