Provider Demographics
NPI:1477606630
Name:PATTERSON, JEFFREY R (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:R
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1300 S CANFIELD NILES RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-4081
Mailing Address - Country:US
Mailing Address - Phone:330-792-9900
Mailing Address - Fax:330-953-0778
Practice Address - Street 1:1300 S CANFIELD NILES RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-4081
Practice Address - Country:US
Practice Address - Phone:330-792-9900
Practice Address - Fax:330-953-0778
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4134152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0743673Medicaid
OHT-1102OtherPRESCRIPTION LICENSE
OH4201430001Medicare NSC
OHT-1102OtherPRESCRIPTION LICENSE
U28919Medicare UPIN