Provider Demographics
NPI:1407021322
Name:PATTERSPN, FLOYD STEPHEN (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:FLOYD
Middle Name:STEPHEN
Last Name:PATTERSPN
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:NA
Other - Middle Name:NA
Other - Last Name:NA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NA
Mailing Address - Street 1:1151 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205-2143
Mailing Address - Country:US
Mailing Address - Phone:908-351-0420
Mailing Address - Fax:908-351-0421
Practice Address - Street 1:1151 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:HILLSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07205-2143
Practice Address - Country:US
Practice Address - Phone:908-351-0420
Practice Address - Fax:908-351-0421
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD-755156FX1800X
NJD755156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician