Individual
THEODORE P PRAWAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1320 WALDEN AVE, BUFFALO, NY 14211-2822
(716) 891-9444
(716) 891-9445
Mailing address
1320 WALDEN AVE, BUFFALO, NY 14211-2822
(716) 891-9444
(716) 891-9445
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
108780
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000503478601
BLUE CROSS OF WNY
NY
05
—
00582852
—
NY
01
—
0803974
INDEPENDENT HEALTH
NY
Enumeration date
08/18/2006
Last updated
07/08/2007
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