Provider Demographics
NPI:1033726716
Name:MANDERS, PATRICK JAMES
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:JAMES
Last Name:MANDERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 PORTER ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-2318
Mailing Address - Country:US
Mailing Address - Phone:860-471-9498
Mailing Address - Fax:
Practice Address - Street 1:52 PORTER ST APT 1
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-2318
Practice Address - Country:US
Practice Address - Phone:860-471-9498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist