Provider Demographics
NPI:1548217755
Name:PATTY VISION CENTER OD PA
Entity Type:Organization
Organization Name:PATTY VISION CENTER OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AUGUSTA
Authorized Official - Middle Name:REID
Authorized Official - Last Name:PATTY
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:336-513-0073
Mailing Address - Street 1:2326 S CHURCH ST STE A
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-5388
Mailing Address - Country:US
Mailing Address - Phone:336-513-0073
Mailing Address - Fax:
Practice Address - Street 1:2326 S CHURCH ST STE A
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5388
Practice Address - Country:US
Practice Address - Phone:336-513-0073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1088152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2326371Medicare PIN