Provider Demographics
NPI:1679679575
Name:PRATT, DAVID B (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
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 1:116 PINK CAMELLIA LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-6507
Mailing Address - Country:US
Mailing Address - Phone:803-397-6255
Mailing Address - Fax:803-356-0515
Practice Address - Street 1:1780 S LAKE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-8102
Practice Address - Country:US
Practice Address - Phone:803-356-1414
Practice Address - Fax:803-356-0515
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1444152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD14447Medicaid
SC9005Medicare PIN