Provider Demographics
NPI:1922279959
Name:NATCHEZ OPITAL
Entity Type:Organization
Organization Name:NATCHEZ OPITAL
Other - Org Name:PATRICK A DUFFY, MD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUFFY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-445-2164
Mailing Address - Street 1:453 JOHN R JUNKIN DR
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-3825
Mailing Address - Country:US
Mailing Address - Phone:601-445-2164
Mailing Address - Fax:318-446-8185
Practice Address - Street 1:453 JOHN R JUNKIN DR
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-3825
Practice Address - Country:US
Practice Address - Phone:601-445-2164
Practice Address - Fax:318-446-8185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07891152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00880176Medicaid
MS00880176Medicaid