Provider Demographics
NPI:1497784755
Name:PATTERSON, PAUL LEE II (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:LEE
Last Name:PATTERSON
Suffix:II
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 1:295 CAMPBELLSVILLE BYPASS
Mailing Address - Street 2:STE 1
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718
Mailing Address - Country:US
Mailing Address - Phone:270-465-4677
Mailing Address - Fax:
Practice Address - Street 1:295 CAMPBELLSVILLE BYPASS
Practice Address - Street 2:STE 1
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718
Practice Address - Country:US
Practice Address - Phone:270-465-4677
Practice Address - Fax:270-465-4677
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1011DT152W00000X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0465020001OtherMEDICARE DME
KY77010114Medicaid
KY9193501Medicare PIN
T54690Medicare UPIN