Provider Demographics
NPI:1073520425
Name:LONOWSKI, PATRICK A (OD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:A
Last Name:LONOWSKI
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 1:4120 HALLMARK WAY
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-4320
Mailing Address - Country:US
Mailing Address - Phone:805-868-7656
Mailing Address - Fax:
Practice Address - Street 1:4120 HALLMARK WAY
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-4320
Practice Address - Country:US
Practice Address - Phone:209-390-4842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 12330 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0123300OtherMEDI-CAL
U97773Medicare UPIN
CAWOP 12330 AMedicare ID - Type Unspecified