Provider Demographics
NPI:1932891660
Name:MOBLEY, PAT (LDO, ABOC, NCLEC)
Entity Type:Individual
Prefix:MRS
First Name:PAT
Middle Name:
Last Name:MOBLEY
Suffix:
Gender:F
Credentials:LDO, ABOC, NCLEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 LAKE SHIRE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-7854
Mailing Address - Country:US
Mailing Address - Phone:803-743-5216
Mailing Address - Fax:
Practice Address - Street 1:733 FASHION DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7936
Practice Address - Country:US
Practice Address - Phone:803-223-0778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC349156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician