Provider Demographics
NPI:1689443541
Name:EBERT, PATRICIA MARY (LICENSED OPTICIAN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MARY
Last Name:EBERT
Suffix:
Gender:F
Credentials:LICENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:25 ELM STREET
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990
Mailing Address - Country:US
Mailing Address - Phone:845-987-7333
Mailing Address - Fax:845-986-9040
Practice Address - Street 1:25 ELM STREET
Practice Address - Street 2:SUITE 3
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990
Practice Address - Country:US
Practice Address - Phone:845-987-7333
Practice Address - Fax:845-986-9040
Is Sole Proprietor?:No
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010526-01156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician