Provider Demographics
NPI:1578902292
Name:DALDINE, PATRICIA SAMUEL (OD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:SAMUEL
Last Name:DALDINE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:PALMA
Other - Last Name:SAMUEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:262 MAIN DUNSTABLE RD
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-1941
Mailing Address - Country:US
Mailing Address - Phone:603-598-1620
Mailing Address - Fax:
Practice Address - Street 1:262 MAIN DUNSTABLE RD
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-1941
Practice Address - Country:US
Practice Address - Phone:603-598-1620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002786152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist