Provider Demographics
NPI:1780784348
Name:PATRICK, SHEA MARIE (OD)
Entity type:Individual
Prefix:MRS
First Name:SHEA
Middle Name:MARIE
Last Name:PATRICK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 RIVER ISLE WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-5310
Mailing Address - Country:US
Mailing Address - Phone:925-330-5220
Mailing Address - Fax:
Practice Address - Street 1:3160 J ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-4403
Practice Address - Country:US
Practice Address - Phone:916-446-2020
Practice Address - Fax:916-446-3128
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 13108 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist