Provider Demographics
NPI:1700845450
Name:PATTON, DAVID A (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:PATTON
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 1:715 CALLAHAN DR
Mailing Address - Street 2:P.O. BOX 12218
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37912
Mailing Address - Country:US
Mailing Address - Phone:865-687-1232
Mailing Address - Fax:865-687-8256
Practice Address - Street 1:715 CALLAHAN DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37912
Practice Address - Country:US
Practice Address - Phone:865-687-1232
Practice Address - Fax:865-687-8256
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN0628152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0708260001OtherMEDICARE, DMERC
TN0708260001OtherMEDICARE, DMERC
TN3594315Medicare ID - Type UnspecifiedMEDICARE GROUP ID