Provider Demographics
NPI:1750345252
Name:PATZMAN, TAYA MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:TAYA
Middle Name:MARIE
Last Name:PATZMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:TAYA
Other - Middle Name:MARIE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1320 CRESTVIEW LN
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-3048
Mailing Address - Country:US
Mailing Address - Phone:701-258-8292
Mailing Address - Fax:
Practice Address - Street 1:1830 E CENTURY AVE
Practice Address - Street 2:STE. 1
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0639
Practice Address - Country:US
Practice Address - Phone:701-222-1140
Practice Address - Fax:701-222-1142
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND612152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND60568Medicaid
ND60568Medicaid
NDU91860Medicare UPIN