Provider Demographics
NPI:1790990547
Name:LAMCKEN, PATTYANN (FNAO)
Entity Type:Individual
Prefix:
First Name:PATTYANN
Middle Name:
Last Name:LAMCKEN
Suffix:
Gender:F
Credentials:FNAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 S DELSEA DR
Mailing Address - Street 2:ST8
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-4400
Mailing Address - Country:US
Mailing Address - Phone:856-696-9283
Mailing Address - Fax:856-696-7248
Practice Address - Street 1:825 S DELSEA DR
Practice Address - Street 2:ST8
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-4400
Practice Address - Country:US
Practice Address - Phone:856-696-9283
Practice Address - Fax:856-696-7248
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTD001438156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5403405Medicaid