Provider Demographics
NPI:1700137759
Name:PATTERSON, REBECCA A
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 HIGHWAY 180 E
Mailing Address - Street 2:SUITE 7
Mailing Address - City:MINERAL WELLS
Mailing Address - State:TX
Mailing Address - Zip Code:76067-4730
Mailing Address - Country:US
Mailing Address - Phone:940-328-0011
Mailing Address - Fax:
Practice Address - Street 1:2801 HIGHWAY 180 E
Practice Address - Street 2:SUITE 7
Practice Address - City:MINERAL WELLS
Practice Address - State:TX
Practice Address - Zip Code:76067-4730
Practice Address - Country:US
Practice Address - Phone:940-328-0011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-29
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician