Individual
PROWSHCHAL MAHATO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5838 METRO WAY SW, WYOMING, MI 49519-9619
(616) 249-5300
Mailing address
2342 WATERTOWN WAY, GRAND RAPIDS, MI 49505-6043
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901005917
MI
Other
Enumeration date
08/20/2025
Last updated
08/20/2025
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