Provider Demographics
NPI:1437644523
Name:SCHREPEL, PATRICK WAYNE (OD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:WAYNE
Last Name:SCHREPEL
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 1:5238 VALLEY TARN
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-2581
Mailing Address - Country:US
Mailing Address - Phone:857-218-8262
Mailing Address - Fax:
Practice Address - Street 1:4465 JIMMY LEE SMITH PKWY STE 101A
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-2723
Practice Address - Country:US
Practice Address - Phone:678-932-5779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003097152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist