Provider Demographics
NPI:1902083280
Name:M. PATRICK DAY, OD, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:M. PATRICK DAY, OD, A PROFESSIONAL CORPORATION
Other - Org Name:CLINTON VISION SOURCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:580-323-5421
Mailing Address - Street 1:PO BOX 606
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-0606
Mailing Address - Country:US
Mailing Address - Phone:580-323-5421
Mailing Address - Fax:866-585-2957
Practice Address - Street 1:565 S 30TH ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-3656
Practice Address - Country:US
Practice Address - Phone:580-323-5421
Practice Address - Fax:866-585-2957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK918152W00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK731048669Medicare UPIN
OK0250380001Medicare NSC
DQ2497Medicare PIN