Provider Demographics
NPI:1235192485
Name:TATE, PATRICK S (O D)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:S
Last Name:TATE
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 N HEBERT AVE
Mailing Address - Street 2:
Mailing Address - City:KAPLAN
Mailing Address - State:LA
Mailing Address - Zip Code:70548-2353
Mailing Address - Country:US
Mailing Address - Phone:225-301-7442
Mailing Address - Fax:
Practice Address - Street 1:2650 VETERANS MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-4007
Practice Address - Country:US
Practice Address - Phone:337-898-0069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1094-298T152WC0802X, 152WX0102X, 156FX1800X, 152WP0200X, 152WS0006X, 152WV0400X, 152W00000X
LALA1094-298T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1699632Medicaid
LAG3226OtherBLUE CROSS BLUE SHIELD
LA$$$$$$$$$OtherCIGNA HEALTHCARE
LA45833OtherSPECTRA
LA1699632Medicaid
LA$$$$$$$$$OtherCIGNA HEALTHCARE
LAP00418089Medicare PIN
LA4B229CM68Medicare PIN
LAU6716Medicare UPIN