Provider Demographics
NPI:1578516944
Name:PATTY, AUGUSTA REID JR (OD)
Entity Type:Individual
Prefix:
First Name:AUGUSTA
Middle Name:REID
Last Name:PATTY
Suffix:JR
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 1:2326 S CHURCH ST
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:336-513-0204
Practice Address - Street 1:2326 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5387
Practice Address - Country:US
Practice Address - Phone:336-513-0073
Practice Address - Fax:336-513-0204
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1088152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909696Medicaid
NC246403Medicare ID - Type Unspecified
NCT64940Medicare UPIN
NC246403KMedicare PIN