Provider Demographics
NPI:1689784415
Name:PATTERSON, D'LISA YVETTE (OD)
Entity Type:Individual
Prefix:DR
First Name:D'LISA
Middle Name:YVETTE
Last Name:PATTERSON
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 1:4609 N RIVER PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-6524
Mailing Address - Country:US
Mailing Address - Phone:414-476-3311
Mailing Address - Fax:
Practice Address - Street 1:130 E CAPITOL DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-1206
Practice Address - Country:US
Practice Address - Phone:414-962-6744
Practice Address - Fax:414-962-6746
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2690152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU67196Medicare UPIN