Provider Demographics
NPI:1437112984
Name:PATTESON, ANGELA MICHELLE (OD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:MICHELLE
Last Name:PATTESON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 SUNSET DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2408
Mailing Address - Country:US
Mailing Address - Phone:423-282-1742
Mailing Address - Fax:423-283-4924
Practice Address - Street 1:302 SUNSET DR
Practice Address - Street 2:SUITE 109
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2408
Practice Address - Country:US
Practice Address - Phone:423-282-1742
Practice Address - Fax:423-283-4924
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2796152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1521262Medicaid
TN1521262Medicaid