Provider Demographics
NPI:1124194949
Name:FLORES, PATRICK L (OD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:L
Last Name:FLORES
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 1:3980 VENTURE DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-5077
Mailing Address - Country:US
Mailing Address - Phone:770-622-3133
Mailing Address - Fax:770-622-8939
Practice Address - Street 1:3980 VENTURE DR
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5077
Practice Address - Country:US
Practice Address - Phone:770-622-3133
Practice Address - Fax:770-622-8939
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT02080152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA8871Medicare UPIN