Provider Demographics
NPI:1679697916
Name:DOYLE, PATRICK KEVIN (OD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:KEVIN
Last Name:DOYLE
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 1:10930 WEYBURN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-2809
Mailing Address - Country:US
Mailing Address - Phone:310-208-1384
Mailing Address - Fax:310-208-1874
Practice Address - Street 1:10930 WEYBURN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-2809
Practice Address - Country:US
Practice Address - Phone:310-208-1384
Practice Address - Fax:310-208-1874
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA7178T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OP7178Medicare PIN
CAU78282Medicare UPIN