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NPI Code Detail

MEDICARE: BRUCE WELTON PRATTE O.D.

MEDICARE: BRUCE WELTON PRATTE 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
1152W00000XOptometrist2836/T601OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000005257OTHEROHANTHEM BLUE CROSS BLUE SH
22220168OTHEROHUNITED HEALTH CARE
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1730108283
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRUCE WELTON PRATTE O.D.
Provider Business Mailing Address
First Line : 1674 N LIMESTONE ST
Second Line :
City : SPRINGFIELD
State : OH
Zip : 45503-2652
Country : US
Telephone Number : 937-322-6411
Fax Number : 937-399-2346
Provider Business Practice Location Address
First Line : 1674 N LIMESTONE ST
Second Line :
City : SPRINGFIELD
State : OH
Zip : 45503-2652
Country : US
Telephone Number : 937-322-6411
Fax Number : 937-399-2346
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2006
Last Update Date : 11/28/2011

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Directions to “ BRUCE WELTON PRATTE O.D.” Practice Location

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