Provider Demographics
NPI:1104824242
Name:PATRICK, CAREY A (OD)
Entity Type:Individual
Prefix:DR
First Name:CAREY
Middle Name:A
Last Name:PATRICK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CAREY
Other - Middle Name:S
Other - Last Name:ASTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1546 STACY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-8726
Mailing Address - Country:US
Mailing Address - Phone:214-383-5400
Mailing Address - Fax:214-383-5203
Practice Address - Street 1:1546 STACY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-8726
Practice Address - Country:US
Practice Address - Phone:214-383-5400
Practice Address - Fax:214-383-5203
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6243TG152WC0802X, 152WP0200X, 152WS0006X
TX06243TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
11411072OtherCAQH
TX162828101Medicaid
TX162828101Medicaid
8B2557Medicare PIN