Provider Demographics
NPI:1417083395
Name:PATTON, GEORGE ARTHUR (OD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:ARTHUR
Last Name:PATTON
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 1:2401 E ORANGEBURG AVE
Mailing Address - Street 2:SUITE # 280
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3351
Mailing Address - Country:US
Mailing Address - Phone:209-525-8436
Mailing Address - Fax:209-525-8438
Practice Address - Street 1:2401 E ORANGEBURG AVE
Practice Address - Street 2:SUITE # 280
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3351
Practice Address - Country:US
Practice Address - Phone:209-525-8436
Practice Address - Fax:209-525-8438
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 7552 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT 10555Medicare UPIN
CADJ027AMedicare PIN
CASD0075520Medicare ID - Type Unspecified