Provider Demographics
NPI:1215920152
Name:KOESTER, PATRICIA HATLEY (OD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:HATLEY
Last Name:KOESTER
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 1:499 E. WINCHESTER BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-4054
Mailing Address - Country:US
Mailing Address - Phone:901-850-2366
Mailing Address - Fax:901-850-2367
Practice Address - Street 1:499 E. WINCHESTER BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-4054
Practice Address - Country:US
Practice Address - Phone:901-850-2366
Practice Address - Fax:901-850-2367
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1757152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU70159Medicare UPIN
TN3941878Medicare PIN