Provider Demographics
NPI:1356386791
Name:PATE, KACY HUFFMAN (OD)
Entity type:Individual
Prefix:MRS
First Name:KACY
Middle Name:HUFFMAN
Last Name:PATE
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 1:317 MATHESON CT
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2270
Mailing Address - Country:US
Mailing Address - Phone:972-393-2352
Mailing Address - Fax:
Practice Address - Street 1:5000 COLLINWOOD AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-3606
Practice Address - Country:US
Practice Address - Phone:817-732-5593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06401TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167384003Medicaid
TXTXB153530OtherMEDICARE PTAN