Provider Demographics
NPI:1740871433
Name:PATINO OPTOMETRIST PC
Entity type:Organization
Organization Name:PATINO OPTOMETRIST PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATINO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:917-745-5869
Mailing Address - Street 1:4004 CASE ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1575
Mailing Address - Country:US
Mailing Address - Phone:917-745-5869
Mailing Address - Fax:917-740-1068
Practice Address - Street 1:4004 CASE ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1575
Practice Address - Country:US
Practice Address - Phone:917-745-5869
Practice Address - Fax:917-740-1068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty