Provider Demographics
NPI:1144371675
Name:PRATT, DARRELL W (OD)
Entity type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:W
Last Name:PRATT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:562 S GREEN RIVER RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-7308
Mailing Address - Country:US
Mailing Address - Phone:812-479-5208
Mailing Address - Fax:812-471-0486
Practice Address - Street 1:562 S GREEN RIVER RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-7308
Practice Address - Country:US
Practice Address - Phone:812-479-5208
Practice Address - Fax:812-471-0486
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002323A152W00000X
KY1145DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100248330AMedicaid
IN849500Medicare ID - Type Unspecified
IN100248330AMedicaid