Provider Demographics
NPI:1316050198
Name:PATTON, LON DOUGLAS (DO)
Entity type:Individual
Prefix:
First Name:LON
Middle Name:DOUGLAS
Last Name:PATTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024
Mailing Address - Country:US
Mailing Address - Phone:440-286-7185
Mailing Address - Fax:440-286-7399
Practice Address - Street 1:325 CENTER ST
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024
Practice Address - Country:US
Practice Address - Phone:440-286-7185
Practice Address - Fax:440-286-7399
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH4039/T590152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMD 2470071Medicaid
OH410030011Medicare PIN
PA0667493Medicare ID - Type Unspecified
U09868Medicare UPIN