Provider Demographics
NPI:1326351982
Name:RICHARD F. PATRICK,O.D.,INC.
Entity Type:Organization
Organization Name:RICHARD F. PATRICK,O.D.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:865-453-2025
Mailing Address - Street 1:120 BRUCE ST
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-3558
Mailing Address - Country:US
Mailing Address - Phone:865-453-2025
Mailing Address - Fax:865-429-1240
Practice Address - Street 1:120 BRUCE ST
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-3558
Practice Address - Country:US
Practice Address - Phone:865-453-2025
Practice Address - Fax:865-429-1240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2305152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3946901Medicaid
39469011Medicare PIN
TNT86928Medicare UPIN