Provider Demographics
NPI:1558563858
Name:DR. PATRICIA PAYNE, OD,INC.
Entity Type:Organization
Organization Name:DR. PATRICIA PAYNE, OD,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:562-634-7000
Mailing Address - Street 1:67 LAKEWOOD CENTER MALL
Mailing Address - Street 2:OPTICAL DEPT
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-2417
Mailing Address - Country:US
Mailing Address - Phone:562-634-7000
Mailing Address - Fax:562-630-0176
Practice Address - Street 1:67 LAKEWOOD CENTER MALL
Practice Address - Street 2:OPTICAL DEPT
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2417
Practice Address - Country:US
Practice Address - Phone:562-634-7000
Practice Address - Fax:562-630-0176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11383T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty