Provider Demographics
NPI:1306103221
Name:HENRY D PATTERSON, OD A PROFESSIONAL OPTOMETRIC CORPORATION
Entity type:Organization
Organization Name:HENRY D PATTERSON, OD A PROFESSIONAL OPTOMETRIC CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:530-356-6833
Mailing Address - Street 1:37333 STATE HIGHWAY 299 E
Mailing Address - Street 2:
Mailing Address - City:BURNEY
Mailing Address - State:CA
Mailing Address - Zip Code:96013-4371
Mailing Address - Country:US
Mailing Address - Phone:530-335-2233
Mailing Address - Fax:530-335-3933
Practice Address - Street 1:37333 STATE HIGHWAY 299 E
Practice Address - Street 2:
Practice Address - City:BURNEY
Practice Address - State:CA
Practice Address - Zip Code:96013-4371
Practice Address - Country:US
Practice Address - Phone:530-335-2233
Practice Address - Fax:530-335-3933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-17
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14348152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty