Provider Demographics
NPI:1598277402
Name:PATTY VISION CENTER OD PA
Entity Type:Organization
Organization Name:PATTY VISION CENTER OD PA
Other - Org Name:MEBANE VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:M
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-599-0246
Mailing Address - Street 1:1107 S FIFTH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-9896
Mailing Address - Country:US
Mailing Address - Phone:919-241-8554
Mailing Address - Fax:336-597-3356
Practice Address - Street 1:1107 S FIFTH ST STE 300
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-9896
Practice Address - Country:US
Practice Address - Phone:919-241-8554
Practice Address - Fax:336-597-3356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty