Provider Demographics
NPI:1235278540
Name:PATTERSON, MICHAEL LEE (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEE
Last Name:PATTERSON
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:PO BOX 419
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38351-0419
Mailing Address - Country:US
Mailing Address - Phone:731-968-2020
Mailing Address - Fax:731-968-2866
Practice Address - Street 1:107 LEXINGTON PLZ
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:TN
Practice Address - Zip Code:38351-1505
Practice Address - Country:US
Practice Address - Phone:731-968-2020
Practice Address - Fax:731-968-2866
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD0000001423152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0164251OtherBLUE CROSS BLUE SHIELD
TN2240165OtherUNITED HEALTHCARE
TN6141OtherTLC MANAGED CARE SERVICES
TN3598568Medicaid
TN3598568Medicaid
3943463Medicare PIN
0659250001Medicare NSC
TN0164251OtherBLUE CROSS BLUE SHIELD
3943464Medicare PIN