Provider Demographics
NPI:1255526844
Name:ROBERT PATTERSON
Entity type:Organization
Organization Name:ROBERT PATTERSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:252-985-1371
Mailing Address - Street 1:PO BOX 7396
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-0396
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1209 CLEVELAND HWY
Practice Address - Street 2:#289
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-8674
Practice Address - Country:US
Practice Address - Phone:252-985-1371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002126152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52049272001OtherBCBS PROVIDER NUMBER
GA265298982AMedicaid
GA52049272001OtherBCBS PROVIDER NUMBER
GA41ZCFVBMedicare PIN