Theodore P Prawak, M.D.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

108780 Issued in NY

Practice address

1320 Walden Ave
Buffalo, NY 14211-2822

Phone

(716) 891-9444

Fax

(716) 891-9445

NPI assigned

Aug 18, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1144334053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 WALDEN AVE",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142112822",
            "telephone_number": "716-891-9444",
            "fax_number": "716-891-9445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 WALDEN AVE",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142112822",
            "telephone_number": "716-891-9444",
            "fax_number": "716-891-9445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRAWAK",
        "first_name": "THEODORE",
        "middle_name": "P",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NY",
            "license": "108780",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENT HEALTH",
            "identifier": "0803974",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF WNY",
            "identifier": "000503478601",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00582852",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pratibha Bansal, MD PC
• Portia Pratt, LPN
• Rebecca E Pratt, MD
• Alexsandra Prawak-Pasieka, M.D.
• Myron Y Prawak, DO
• Premier Health Partners
• Premier Pharmacy LLC
• Premium Ppe, LLC
• Nora Prendergast, PHARMD
• Jeremiah Andrew Prentice

• Ophthalmology Physician in Buffalo, NY
• Providers in Buffalo, NY by specialty
• Ophthalmology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.