Provider Demographics
NPI:1689707754
Name:PATE, JENNIFER RIGGS (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:RIGGS
Last Name:PATE
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 1:5126 VALERIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-8601
Mailing Address - Country:US
Mailing Address - Phone:205-425-7877
Mailing Address - Fax:
Practice Address - Street 1:2000 RIVERCHASE GALLERIA STE 241
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-2322
Practice Address - Country:US
Practice Address - Phone:205-985-0925
Practice Address - Fax:205-985-7880
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS832TA383152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU67171Medicare UPIN