Provider Demographics
NPI:1164642138
Name:PATTERSON OPTICAL, P.A.
Entity type:Organization
Organization Name:PATTERSON OPTICAL, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:903-868-2020
Mailing Address - Street 1:4180 TOWN CTR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-2567
Mailing Address - Country:US
Mailing Address - Phone:903-868-2020
Mailing Address - Fax:903-813-1426
Practice Address - Street 1:4180 TOWN CTR
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-2567
Practice Address - Country:US
Practice Address - Phone:903-868-2020
Practice Address - Fax:903-813-1426
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATTERSON OPTICAL, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-01
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4133TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019497902Medicaid