Provider Demographics
NPI:1154772572
Name:HERNACKI, PATRICIA M (OD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:HERNACKI
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 1:301 SADDLE DR STE B
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-8026
Mailing Address - Country:US
Mailing Address - Phone:406-442-3937
Mailing Address - Fax:406-442-3366
Practice Address - Street 1:301 SADDLE DR STE B
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-8026
Practice Address - Country:US
Practice Address - Phone:406-442-3937
Practice Address - Fax:406-442-3366
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4936152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty