Provider Demographics
NPI:1689714909
Name:FOX, PATRICIA (OD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:FOX
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 1:22 BUENA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-7511
Mailing Address - Country:US
Mailing Address - Phone:617-859-0630
Mailing Address - Fax:617-859-0632
Practice Address - Street 1:10 HUNTINGTON AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-5707
Practice Address - Country:US
Practice Address - Phone:617-859-0630
Practice Address - Fax:617-859-0632
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3507152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0356786Medicaid
MAW17303Medicare ID - Type UnspecifiedMEDICARE
MA0356786Medicaid