Provider Demographics
NPI:1154453199
Name:HAZELL, PATRICIA LYN (OD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:LYN
Last Name:HAZELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 SAMS CIR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4694
Mailing Address - Country:US
Mailing Address - Phone:617-699-7487
Mailing Address - Fax:757-548-1266
Practice Address - Street 1:1521 SAMS CIR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4694
Practice Address - Country:US
Practice Address - Phone:757-436-6546
Practice Address - Fax:757-548-1266
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4831152W00000X
VA0618002872152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U85029Medicare UPIN