Provider Demographics
NPI:1376631275
Name:PATTERSON, RONALD MAURICE (OD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:MAURICE
Last Name:PATTERSON
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 1:2917 W KENNEDY BLVD
Mailing Address - Street 2:SUITE # 110
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609
Mailing Address - Country:US
Mailing Address - Phone:813-871-2020
Mailing Address - Fax:813-871-2021
Practice Address - Street 1:2917 W KENNEDY BLVD
Practice Address - Street 2:SUITE # 110
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609
Practice Address - Country:US
Practice Address - Phone:813-871-2020
Practice Address - Fax:813-871-2021
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1685152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
20988Medicare ID - Type Unspecified
U86306Medicare UPIN