Provider Demographics
NPI:1497910525
Name:DR. LUCIA PATINO, OPTOMETRIST, PC
Entity Type:Organization
Organization Name:DR. LUCIA PATINO, OPTOMETRIST, PC
Other - Org Name:DR. LUCIA PATINO, OPTOMETRIST, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATINO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-505-9401
Mailing Address - Street 1:8114 ROOSEVELT AVENUE
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372
Mailing Address - Country:US
Mailing Address - Phone:718-505-9401
Mailing Address - Fax:718-505-9403
Practice Address - Street 1:8114 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6746
Practice Address - Country:US
Practice Address - Phone:718-505-9401
Practice Address - Fax:718-505-9403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT 006595152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03025981Medicaid