Provider Demographics
NPI:1346348042
Name:UTNEHMER, PATRICK WILLIAM (OD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:WILLIAM
Last Name:UTNEHMER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:40764 WINCHESTER RD STE 580
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-6502
Mailing Address - Country:US
Mailing Address - Phone:951-296-2211
Mailing Address - Fax:951-296-2032
Practice Address - Street 1:40764 WINCHESTER RD STE 580
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-6502
Practice Address - Country:US
Practice Address - Phone:951-296-2211
Practice Address - Fax:951-296-2032
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT8131152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB723ZMedicare PIN