Provider Demographics
NPI:1669463352
Name:PATTERSON, WILLIAM RAY (OD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RAY
Last Name:PATTERSON
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 1:2505 DONAGHEY AVE.
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032
Mailing Address - Country:US
Mailing Address - Phone:501-940-9900
Mailing Address - Fax:501-932-0201
Practice Address - Street 1:2505 DONAGHEY AVE.
Practice Address - Street 2:SUITE 102
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032
Practice Address - Country:US
Practice Address - Phone:501-450-9900
Practice Address - Fax:501-932-0201
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2367152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR114822722Medicaid
AR47600Medicare ID - Type Unspecified
AR114822722Medicaid