Provider Demographics
NPI:1174559348
Name:PRUSZENSKI, AMY DEE (OD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:DEE
Last Name:PRUSZENSKI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:DEE
Other - Last Name:SHORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:161 DEER ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-3905
Mailing Address - Country:US
Mailing Address - Phone:603-430-0211
Mailing Address - Fax:603-430-7333
Practice Address - Street 1:161 DEER ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-3905
Practice Address - Country:US
Practice Address - Phone:603-430-0211
Practice Address - Fax:603-430-7333
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH609152WP0200X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Not Answered152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30011325Medicaid
NH4834506OtherCIGNA
NHRE7493NHOtherANTHEM BCBS
NHNA1160OtherHARVARD PILGRIM HEALTHCAR
NHRE4214Medicare ID - Type UnspecifiedEYECARE
NH30011325Medicaid