Provider Demographics
NPI:1386073443
Name:PATNODE, TAMMY
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:PATNODE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 FLAT ROCK RD
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-2604
Mailing Address - Country:US
Mailing Address - Phone:518-483-8788
Mailing Address - Fax:
Practice Address - Street 1:156 FLAT ROCK RD
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-2604
Practice Address - Country:US
Practice Address - Phone:518-483-8788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008213156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician