Provider Demographics
NPI:1942351218
Name:BAILEY, PATRICIA LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:LYNN
Last Name:BAILEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 SW SCOTT PL
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32024-3897
Mailing Address - Country:US
Mailing Address - Phone:386-965-5205
Mailing Address - Fax:386-330-2592
Practice Address - Street 1:2469 W US HIGHWAY 90 # A-27
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-4738
Practice Address - Country:US
Practice Address - Phone:386-515-8647
Practice Address - Fax:386-361-7819
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP0003121152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620647600Medicaid
FL40221Medicare PIN
FL20828WMedicare PIN
FLIN729AMedicare PIN
FL620647600Medicaid
FL40221BMedicare PIN
FL20828UMedicare PIN
FL20828ZMedicare PIN