Provider Demographics
NPI:1255435517
Name:ATIE, PATRICIA ADRIANA (OD, FCOVD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ADRIANA
Last Name:ATIE
Suffix:
Gender:F
Credentials:OD, FCOVD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 S FAIRVIEW
Mailing Address - Street 2:#103
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704
Mailing Address - Country:US
Mailing Address - Phone:714-557-9492
Mailing Address - Fax:714-557-2548
Practice Address - Street 1:2414 S FAIRVIEW
Practice Address - Street 2:#103
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704
Practice Address - Country:US
Practice Address - Phone:714-557-9492
Practice Address - Fax:714-557-2548
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8962T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0089620Medicaid
CASD0089620Medicaid
CASD0089620Medicaid
MA0655526OtherDEA