Provider Demographics
NPI:1841375367
Name:PRINCE, PATRICIA HUDGINS (AAS BS)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:HUDGINS
Last Name:PRINCE
Suffix:
Gender:F
Credentials:AAS BS
Other - Prefix:MISS
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:PRINCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:KILMARNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22482-0369
Mailing Address - Country:US
Mailing Address - Phone:804-435-2646
Mailing Address - Fax:
Practice Address - Street 1:266D N. MAIN ST.
Practice Address - Street 2:266D
Practice Address - City:KILMARNOCK
Practice Address - State:VA
Practice Address - Zip Code:22482-0369
Practice Address - Country:US
Practice Address - Phone:804-435-2646
Practice Address - Fax:804-435-2620
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101001436156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0170100001Medicare ID - Type Unspecified