Provider Demographics
NPI:1902907397
Name:DAYLOR, PATRICIA
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:DAYLOR
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 1:4028 COX RD STE M
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-6702
Mailing Address - Country:US
Mailing Address - Phone:804-217-9883
Mailing Address - Fax:804-217-9065
Practice Address - Street 1:4028 COX RD STE M
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-6702
Practice Address - Country:US
Practice Address - Phone:804-217-9883
Practice Address - Fax:804-217-9065
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000036152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAA100260Medicare PIN
U68344Medicare UPIN
410001018Medicare ID - Type Unspecified