Provider Demographics
NPI:1376589234
Name:PATE, RENA MELTON (OD)
Entity Type:Individual
Prefix:DR
First Name:RENA
Middle Name:MELTON
Last Name:PATE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4051 NICHOLASVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-4432
Mailing Address - Country:US
Mailing Address - Phone:859-971-0589
Mailing Address - Fax:859-971-0591
Practice Address - Street 1:4051 NICHOLASVILLE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-4432
Practice Address - Country:US
Practice Address - Phone:859-971-0589
Practice Address - Fax:859-971-0591
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1636DT152W00000X
TX6761TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77001477Medicaid
KY000000368848OtherBLUE CROSS BLUE SHIELD
KY77001477Medicaid
KYV05883Medicare UPIN