Provider Demographics
NPI:1497837751
Name:PATERA, THOMAS PATRICK (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:PATRICK
Last Name:PATERA
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 1:1823 S 194TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-3770
Mailing Address - Country:US
Mailing Address - Phone:402-763-9498
Mailing Address - Fax:
Practice Address - Street 1:5001 SERGEANT RD
Practice Address - Street 2:SUITE 45
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-4775
Practice Address - Country:US
Practice Address - Phone:712-224-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01683152W00000X
NE1017152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100250180-00Medicaid
IA3160648Medicaid
IA3160648Medicaid
NE100250180-00Medicaid