Provider Demographics
NPI:1407102288
Name:PATRICK, JOSHUA (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
Last Name:PATRICK
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 1:100 HOSPITAL DR W
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1334
Mailing Address - Country:US
Mailing Address - Phone:601-268-5910
Mailing Address - Fax:601-264-0659
Practice Address - Street 1:100 HOSPITAL DR W
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1334
Practice Address - Country:US
Practice Address - Phone:601-268-5910
Practice Address - Fax:601-264-0659
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS868152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist