Provider Demographics
NPI:1093763138
Name:MCGRATH, PATRICK KEVIN (OD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:KEVIN
Last Name:MCGRATH
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 1:310 E OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-2841
Mailing Address - Country:US
Mailing Address - Phone:719-336-3311
Mailing Address - Fax:
Practice Address - Street 1:310 E OLIVE ST
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052-2841
Practice Address - Country:US
Practice Address - Phone:719-336-3311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1102152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08011025Medicaid
43933Medicare ID - Type Unspecified
CO08011025Medicaid
T70183Medicare UPIN