Provider Demographics
NPI:1194756577
Name:PATTERSON, ROBERT STOKES (OD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:STOKES
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 HAMILTON PLACE BLVD
Mailing Address - Street 2:SUITE 200 SEARS OPTICAL
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-6017
Mailing Address - Country:US
Mailing Address - Phone:423-892-2661
Mailing Address - Fax:423-892-1399
Practice Address - Street 1:2100 HAMILTON PLACE BLVD
Practice Address - Street 2:SUITE 200 SEARS OPTICAL
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-6017
Practice Address - Country:US
Practice Address - Phone:423-892-2661
Practice Address - Fax:423-892-1399
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1612152W00000X
GAOPT002126152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
103I419668OtherMEDICARE PTAN
GA265298982AMedicaid
TN4125087OtherBCBS & TNCARE SELECT #
TN4130051OtherTENNCARE SELECT PROV #
TN3941325Medicaid
TNP00258494OtherRAILROAD MEDICARE PROV #
GA52049272001OtherBCBS PROVIDER NUMBER
GA265298982AMedicaid
GA265298982AMedicaid