Provider Demographics
NPI:1568430924
Name:MAGEE, PATRICK R (OD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:R
Last Name:MAGEE
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 1:4510 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6931
Mailing Address - Country:US
Mailing Address - Phone:337-984-2020
Mailing Address - Fax:337-989-0374
Practice Address - Street 1:5605 AMBASSADOR CAFFERY PKWY STE 100
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:LA
Practice Address - Zip Code:70592-5180
Practice Address - Country:US
Practice Address - Phone:337-984-2020
Practice Address - Fax:337-989-0374
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA916-070T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA72-1195524OtherT.I.D.
LA1034126Medicaid
LA47814Medicare PIN