Provider Demographics
NPI:1043206105
Name:PATRICK, DARREN MORGAN (OD)
Entity Type:Individual
Prefix:DR
First Name:DARREN
Middle Name:MORGAN
Last Name:PATRICK
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 1:10001 TAYLORSVILLE RD STE D
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-3116
Mailing Address - Country:US
Mailing Address - Phone:502-290-6444
Mailing Address - Fax:502-290-5645
Practice Address - Street 1:10001 TAYLORSVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-3116
Practice Address - Country:US
Practice Address - Phone:502-290-6444
Practice Address - Fax:502-290-5645
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1488DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77000255Medicaid
KY77000255Medicaid
MP0580010OtherDEA
KY4970700001Medicare NSC
KY77000255Medicaid