Provider Demographics
NPI:1578543062
Name:PATTISON, MICHAEL DUANE (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DUANE
Last Name:PATTISON
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:TSVCRD, APHC, ATTN: MCHB-PH-VCR
Mailing Address - Street 2:8252 BLACKHAWK ROAD
Mailing Address - City:ABERDEEN PROVING GROUND
Mailing Address - State:MD
Mailing Address - Zip Code:21010-5403
Mailing Address - Country:US
Mailing Address - Phone:410-417-3735
Mailing Address - Fax:410-436-1325
Practice Address - Street 1:TSVCRD, APHC, ATTN: MCHB-PH-VCR
Practice Address - Street 2:8252 BLACKHAWK ROAD
Practice Address - City:ABERDEEN PROVING GROUND
Practice Address - State:MD
Practice Address - Zip Code:21010-5403
Practice Address - Country:US
Practice Address - Phone:410-417-3735
Practice Address - Fax:410-436-1325
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2825152W00000X
TX3734152W00000X
MDTA 2034152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist