Provider Demographics
NPI:1457489437
Name:WALTER, PATRINA SATTIEWHITE (OD)
Entity Type:Individual
Prefix:DR
First Name:PATRINA
Middle Name:SATTIEWHITE
Last Name:WALTER
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 1:13509 N MERIDIAN AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8396
Mailing Address - Country:US
Mailing Address - Phone:405-751-0075
Mailing Address - Fax:405-767-0907
Practice Address - Street 1:13509 N MERIDIAN AVE STE 3
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8396
Practice Address - Country:US
Practice Address - Phone:405-751-0075
Practice Address - Fax:405-767-0907
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2228152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100765090AMedicaid
OKU67454Medicare UPIN