Provider Demographics
NPI:1205018223
Name:KATRINA VAN PATTEN, O.D. LTD.
Entity Type:Organization
Organization Name:KATRINA VAN PATTEN, O.D. LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN PATTEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:775-882-3977
Mailing Address - Street 1:410 FLEISCHMANN WAY
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-2984
Mailing Address - Country:US
Mailing Address - Phone:775-882-3977
Mailing Address - Fax:775-882-3285
Practice Address - Street 1:410 FLEISCHMANN WAY
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-2984
Practice Address - Country:US
Practice Address - Phone:775-882-3977
Practice Address - Fax:775-882-3285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV200261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV0300070001Medicare NSC
NVV105089Medicare PIN
NVU12874Medicare UPIN