Provider Demographics
NPI:1720522386
Name:PENDER, PATRICK (RDO)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:
Last Name:PENDER
Suffix:
Gender:M
Credentials:RDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 BOSTON TPKE
Mailing Address - Street 2:UNIT 2B
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-3601
Mailing Address - Country:US
Mailing Address - Phone:508-454-4912
Mailing Address - Fax:
Practice Address - Street 1:84 BOSTON TPKE
Practice Address - Street 2:UNIT 2B
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-3601
Practice Address - Country:US
Practice Address - Phone:508-454-4912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4029156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA8850Medicare PIN