Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1992ATI | OR |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 1992ATI | OR |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | 1992ATI | OR |
N | 152WP0200X | Pediatric Optomitrist | 1992ATI | OR |
N | 152WS0006X | Sports Vision | 1992ATI | OR |
N | 152WV0400X | Optomitrist - Vision Therapist | 1992ATI | OR |
N | 152WX0102X | Occupational Vision | 1992ATI | OR |
NPI | 1255317665 |
---|---|
Provider Name | Dr. Patricia B Gates |
First Address | Coos Bay, OR 97420-0034 |
Second Address | Coos Bay, OR 97420-1736 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2005 |
Last Update Date | 27/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
015359 | (05) | OR |
U12105 | (02) | OR |