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NPI Code Detail

MEDICARE: MRS. KACY HUFFMAN PATE O.D.

MEDICARE: MRS. KACY HUFFMAN PATE O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist06401TGTX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2TXB153530OTHERTXMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356386791
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KACY HUFFMAN PATE O.D.
Provider Business Mailing Address
First Line : 317 MATHESON CT
Second Line :
City : COPPELL
State : TX
Zip : 75019-2270
Country : US
Telephone Number : 972-393-2352
Fax Number :
Provider Business Practice Location Address
First Line : 5000 COLLINWOOD AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76107-3606
Country : US
Telephone Number : 817-732-5593
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2006
Last Update Date : 09/29/2020

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