Provider Demographics
NPI:1699753178
Name:PATTERSON, JAMES R (OPTOMETRY)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:R
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:OPTOMETRY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 MIFFLIN AVE SUITE 110
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-3443
Mailing Address - Country:US
Mailing Address - Phone:419-289-0808
Mailing Address - Fax:419-281-1200
Practice Address - Street 1:2212 MIFFLIN AVE SUITE 110
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-3443
Practice Address - Country:US
Practice Address - Phone:419-289-0808
Practice Address - Fax:419-281-1200
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3562152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0468855Medicaid
OH0504273Medicare PIN
OH0468855Medicaid