MEDICARE: DR. EFREM JONATHAN PRADO O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	942991598	CA

General Provider Information

NPI Number	:	1578876447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EFREM JONATHAN PRADO O.D.

Provider Business Mailing Address
First Line	:	3625 MIDWAY DR
Second Line	:	STE P
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-5253
Country	:	US
Telephone Number	:	510-461-3931
Fax Number	:

Provider Business Practice Location Address
First Line	:	3625 MIDWAY DR
Second Line	:	STE P
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-5253
Country	:	US
Telephone Number	:	619-223-3028
Fax Number	:	619-223-3042

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2010
Last Update Date	:	04/20/2016

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