Provider Demographics
NPI:1770735847
Name:PATRICK PADRNOS O.D. P.C.
Entity type:Organization
Organization Name:PATRICK PADRNOS O.D. P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:PADRNOS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:928-779-5600
Mailing Address - Street 1:1135 S PLAZA WAY
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-6317
Mailing Address - Country:US
Mailing Address - Phone:928-779-5600
Mailing Address - Fax:928-779-5701
Practice Address - Street 1:1135 S PLAZA WAY
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-6317
Practice Address - Country:US
Practice Address - Phone:928-779-5600
Practice Address - Fax:928-779-5701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ646152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ69520Medicare PIN
AZU13236Medicare UPIN