Provider Demographics
NPI:1427030717
Name:PATTNI, SAMIR (OD)
Entity Type:Individual
Prefix:
First Name:SAMIR
Middle Name:
Last Name:PATTNI
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 1:2821 W PARKER RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-7950
Mailing Address - Country:US
Mailing Address - Phone:972-596-3800
Mailing Address - Fax:
Practice Address - Street 1:2821 W PARKER RD
Practice Address - Street 2:SUITE 1
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-7950
Practice Address - Country:US
Practice Address - Phone:972-596-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4757TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F21704OtherMEDICARE PTAN INDIVIDUAL
TX0A4530OtherMEDICARE GROUP PTAN
TXOOE12YOtherMEDICARE PROVIDER NUMBER
TXOOE12YOtherMEDICARE PROVIDER NUMBER