Provider Demographics
NPI:1689962862
Name:MILLESON, PATRICK EVAN (OD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:EVAN
Last Name:MILLESON
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 1:220 SOUTH 6TH STREET
Mailing Address - Street 2:P.O. BOX 643
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-0643
Mailing Address - Country:US
Mailing Address - Phone:740-532-2020
Mailing Address - Fax:740-532-0176
Practice Address - Street 1:220 SOUTH 6TH STREET
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-0643
Practice Address - Country:US
Practice Address - Phone:740-532-2020
Practice Address - Fax:740-532-0176
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6057 T2972152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist