Provider Demographics
NPI:1538325519
Name:PATRICK, MYRON
Entity Type:Individual
Prefix:MR
First Name:MYRON
Middle Name:
Last Name:PATRICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 N RUNNELS ST
Mailing Address - Street 2:
Mailing Address - City:DE KALB
Mailing Address - State:TX
Mailing Address - Zip Code:75559-1440
Mailing Address - Country:US
Mailing Address - Phone:903-667-2015
Mailing Address - Fax:903-667-0930
Practice Address - Street 1:109 N RUNNELS ST
Practice Address - Street 2:
Practice Address - City:DE KALB
Practice Address - State:TX
Practice Address - Zip Code:75559-1440
Practice Address - Country:US
Practice Address - Phone:903-667-2015
Practice Address - Fax:903-667-0930
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician