Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist |
NPI | 1972790814 |
---|---|
Provider Name | Mr. Craig R. Pataky |
First Address | Austin, TX 78756-3313 |
Second Address | Austin, TX 78756-3313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2007 |
Last Update Date | 11/09/2017 |