Provider Demographics
NPI:1760558902
Name:O BRIEN, PATRICIA J (OD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:J
Last Name:O BRIEN
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNIT 6 W
Mailing Address - Street 2:KAISER PERM MID ATL PERM MED GRP PC ATTN T. BROOKS
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-6660
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:12255 FAIR LAKES PARKWAY
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-3952
Practice Address - Country:US
Practice Address - Phone:703-934-5905
Practice Address - Fax:703-934-5778
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2021-06-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0618000452152W00000X
VA0601001523152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U50667Medicare UPIN
013689K92Medicare ID - Type Unspecified