Provider Demographics
NPI:1477619955
Name:PATERSON, GEOFFREY (OD)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:
Last Name:PATERSON
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 1:811 PARKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-1715
Mailing Address - Country:US
Mailing Address - Phone:610-566-7026
Mailing Address - Fax:
Practice Address - Street 1:811 PARKRIDGE DR
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-1715
Practice Address - Country:US
Practice Address - Phone:610-566-7026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ5619152W00000X
PAOEG1759152W00000X
LA1124152W00000X
WA3083152W00000X
DEI3-0001255152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1991155Medicaid
LAU51442Medicare UPIN
LA4B204Medicare ID - Type Unspecified
LA1991155Medicaid