Provider Demographics
NPI:1356486294
Name:BEHREND, PATRICIA (OPTICIAN)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:BEHREND
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 STOKES RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-3011
Mailing Address - Country:US
Mailing Address - Phone:609-654-4988
Mailing Address - Fax:609-654-4991
Practice Address - Street 1:709 STOKES ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-3002
Practice Address - Country:US
Practice Address - Phone:609-654-4988
Practice Address - Fax:609-654-4991
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD1554156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician