Provider Demographics
NPI:1760607071
Name:PATRICK SQUIRES OD AND ASSOCIATES, INC.
Entity Type:Organization
Organization Name:PATRICK SQUIRES OD AND ASSOCIATES, INC.
Other - Org Name:EYE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SQUIRES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:360-734-6464
Mailing Address - Street 1:PO BOX 29317
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98228-1317
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1303 CORNWALL AVE
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4716
Practice Address - Country:US
Practice Address - Phone:360-647-0421
Practice Address - Fax:360-733-5585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB16225OtherMEDICARE GROUP #
WA2015972Medicaid
WAGAB16225OtherMEDICARE GROUP #
WA2015972Medicaid