Frank Edwin Prukop, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

5487T Issued in TX

Practice address

1133 General Cavazos Blvd
Kingsville, TX 78363-7100

Phone

(361) 516-0888

Fax

(361) 516-0880

NPI assigned

Feb 23, 2007

Last updated

Mar 7, 2023By the provider in NPPES

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 7

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1780719146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 REIDDA DR",
            "city": "KINGSVILLE",
            "state": "TX",
            "postal_code": "783637701",
            "telephone_number": "361-595-4421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1133 GENERAL CAVAZOS BLVD",
            "city": "KINGSVILLE",
            "state": "TX",
            "postal_code": "783637100",
            "telephone_number": "361-516-0888",
            "fax_number": "361-516-0880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUKOP",
        "first_name": "FRANK",
        "middle_name": "EDWIN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-23",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "5487T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPECTERA PROVIDER ID",
            "identifier": "14919",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTICARE PROVIDER #",
            "identifier": "25812",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NVA PROVIDER #",
            "identifier": "454087",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER #",
            "identifier": "0054FB",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE #",
            "identifier": "5487T",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DAVIS VISION PROVIDER #",
            "identifier": "44212",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLOCK VISION PROVIDER ID#",
            "identifier": "919677",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Kingsville, TX
• Providers in Kingsville, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.