Provider Demographics
NPI:1972935039
Name:PRYTULA, ERIC MICHAEL (OD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:MICHAEL
Last Name:PRYTULA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1277 HARTFORD AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-7121
Mailing Address - Country:US
Mailing Address - Phone:401-521-3606
Mailing Address - Fax:401-453-3288
Practice Address - Street 1:1277 HARTFORD AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-7121
Practice Address - Country:US
Practice Address - Phone:401-521-3606
Practice Address - Fax:401-453-3288
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTG00601152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist