Provider Demographics
NPI:1679648091
Name:MILBURN, PATRICK (OD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:
Last Name:MILBURN
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 1:6046 DEVONSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-1637
Mailing Address - Country:US
Mailing Address - Phone:661-533-9689
Mailing Address - Fax:661-533-9689
Practice Address - Street 1:37140 47TH ST E
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93552-4450
Practice Address - Country:US
Practice Address - Phone:661-533-9689
Practice Address - Fax:661-533-9689
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT09914T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT09914TOtherOPTOMETRY LICENSE NUMBER
U37664Medicare UPIN