Provider Demographics
NPI:1932369147
Name:VELTMAN, PATRICIA MARY (LDO)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MARY
Last Name:VELTMAN
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 SE US HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-4830
Mailing Address - Country:US
Mailing Address - Phone:352-563-1666
Mailing Address - Fax:352-563-1673
Practice Address - Street 1:1661 SE US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-4830
Practice Address - Country:US
Practice Address - Phone:352-563-1666
Practice Address - Fax:352-563-1673
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO4422156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL630108800Medicaid