Provider Demographics
NPI:1114096146
Name:SQUIRES, PATRICK GERARD (OD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:GERARD
Last Name:SQUIRES
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:PO BOX 29317
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98228-1317
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:405 32ND ST
Practice Address - Street 2:STE. 103
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-0951
Practice Address - Country:US
Practice Address - Phone:360-734-6464
Practice Address - Fax:360-733-5585
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3073TX152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB16225OtherMEDICARE GROUP #
WA2015972Medicaid
WA130706OtherLABOR AND INDUSTRIES
WA74309OtherREGENCE BLUE SHIELD
WAGAB17311Medicare PIN
WAGAB16225OtherMEDICARE GROUP #