Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 1094-298T | LA |
Y | 152W00000X | Optometrist | LA1094-298T | LA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 1094-298T | LA |
N | 152WP0200X | Pediatric Optomitrist | 1094-298T | LA |
N | 152WS0006X | Sports Vision | 1094-298T | LA |
N | 152WV0400X | Optomitrist - Vision Therapist | 1094-298T | LA |
N | 152WX0102X | Occupational Vision | 1094-298T | LA |
N | 156FX1800X | Optician | 1094-298T | LA |
NPI | 1235192485 |
---|---|
Provider Name | Dr. Patrick S. Tate |
First Address | Zachary, LA 70791-7384 |
Second Address | Zachary, LA 70791-7384 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2006 |
Last Update Date | 04/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
$$$$$$$$$ | CIGNA HEALTHCARE (01) | LA |
1699632 | (05) | LA |
45833 | SPECTRA (01) | LA |
G3226 | BLUE CROSS BLUE SHIELD (01) | LA |
U6716 | (02) | LA |