Provider Demographics
NPI:1417255100
Name:CREATURA, PATRICIA JEANNE (OD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:JEANNE
Last Name:CREATURA
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 1:3770 NORTHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-3738
Mailing Address - Country:US
Mailing Address - Phone:216-321-0811
Mailing Address - Fax:
Practice Address - Street 1:3547 MIDWAY MALL
Practice Address - Street 2:EYEMASTERS
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-2458
Practice Address - Country:US
Practice Address - Phone:440-324-9779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4337 T909152W00000X
MA3327152W00000X
IL046-008067152W00000X
NYT004731152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0936491Medicaid
OH0936491Medicaid
OHU46992Medicare UPIN