Provider Demographics
NPI:1740339449
Name:PATTY VISION CENTER OD PA
Entity type:Organization
Organization Name:PATTY VISION CENTER OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AUGUSTA
Authorized Official - Middle Name:REID
Authorized Official - Last Name:PATTY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:336-599-0246
Mailing Address - Street 1:415 SEMORA RD
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27573-5185
Mailing Address - Country:US
Mailing Address - Phone:336-599-0246
Mailing Address - Fax:336-597-3356
Practice Address - Street 1:415 SEMORA RD
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-5185
Practice Address - Country:US
Practice Address - Phone:336-599-0246
Practice Address - Fax:336-597-3356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC014C5OtherBCBS PIN
NC5915918Medicaid
NC014C5OtherBCBS PIN
NCDQ2068Medicare PIN