Provider Demographics
NPI:1790888196
Name:AUSTIN, PATRICIA L (MD, INC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:MD, INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 ARROYO WAY
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-4216
Mailing Address - Country:US
Mailing Address - Phone:925-945-8188
Mailing Address - Fax:925-945-0360
Practice Address - Street 1:1270 ARROYO WAY
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4216
Practice Address - Country:US
Practice Address - Phone:925-945-8188
Practice Address - Fax:925-945-0360
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29698207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA18000244490Medicare PIN
CA00A296980Medicare PIN
A25852Medicare UPIN
CA0949120001Medicare NSC