Provider Demographics
NPI:1710071535
Name:DUFFY, PATRICK M (OD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:M
Last Name:DUFFY
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 1:4930 N BERNARD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-5146
Mailing Address - Country:US
Mailing Address - Phone:773-539-7686
Mailing Address - Fax:776-685-1607
Practice Address - Street 1:4930 N BERNARD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-5146
Practice Address - Country:US
Practice Address - Phone:773-539-7686
Practice Address - Fax:776-685-1607
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180112Medicare UPIN