Provider Demographics
NPI:1225153299
Name:PAYNE, PATRICIA D
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:D
Last Name:PAYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:PATRICIA
Other - Middle Name:D
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:2286 E CARSON ST
Mailing Address - Street 2:#246
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3044
Mailing Address - Country:US
Mailing Address - Phone:714-676-8620
Mailing Address - Fax:
Practice Address - Street 1:67 LAKEWOOD CENTER MALL
Practice Address - Street 2:J C PENNEY OPTICAL
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2417
Practice Address - Country:US
Practice Address - Phone:562-634-7000
Practice Address - Fax:562-630-0176
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11383T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist