Provider Demographics
NPI:1497813877
Name:HANKS, PATRICIA (OD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:HANKS
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 1:54 RIVER BLUFF CT
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-6068
Mailing Address - Country:US
Mailing Address - Phone:803-279-6312
Mailing Address - Fax:
Practice Address - Street 1:FORT GORDON PXTRA, BLDG. 35200
Practice Address - Street 2:OPTOMETRY CENTER
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905
Practice Address - Country:US
Practice Address - Phone:706-771-9403
Practice Address - Fax:706-771-9167
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001250152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU46549Medicare UPIN
GA41ZCFVNMedicare ID - Type Unspecified