Provider Demographics
NPI:1659483683
Name:PATINO, LUCIA (OD)
Entity Type:Individual
Prefix:DR
First Name:LUCIA
Middle Name:
Last Name:PATINO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8114 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-6746
Mailing Address - Country:US
Mailing Address - Phone:347-858-2761
Mailing Address - Fax:718-505-9403
Practice Address - Street 1:8114 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6746
Practice Address - Country:US
Practice Address - Phone:718-505-9401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006595152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02828811Medicaid
NYG400000253OtherMEDICARE PTAN