Provider Demographics
NPI:1275571051
Name:DOOLEY, PATRICK M (OD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:M
Last Name:DOOLEY
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 1:314 JACKSONVILLE MALL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-7316
Mailing Address - Country:US
Mailing Address - Phone:910-353-9200
Mailing Address - Fax:910-353-5459
Practice Address - Street 1:314 JACKSONVILLE MALL
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-7316
Practice Address - Country:US
Practice Address - Phone:910-353-9200
Practice Address - Fax:910-353-5459
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1415152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890902KMedicaid
NC2468987Medicare ID - Type Unspecified
NCU50512Medicare UPIN