Provider Demographics
NPI:1679515464
Name:PATTON FAMILY OPTOMETRY, INC
Entity type:Organization
Organization Name:PATTON FAMILY OPTOMETRY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:COX
Authorized Official - Last Name:PATTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:601-398-4662
Mailing Address - Street 1:120 DISTRICT BLVD STE D109
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-6382
Mailing Address - Country:US
Mailing Address - Phone:601-398-4662
Mailing Address - Fax:601-398-4669
Practice Address - Street 1:120 DISTRICT BLVD STE D109
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211
Practice Address - Country:US
Practice Address - Phone:601-398-4662
Practice Address - Fax:601-398-4669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS663152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSU53917Medicare UPIN