MEDICARE: MR. CRAIG R. PATAKY B.C.O.

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
1	156FX1700X	Ocularist

General Provider Information

NPI Number	:	1972790814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CRAIG R. PATAKY B.C.O.

Provider Business Mailing Address
First Line	:	4409 MEDICAL PKWY
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-3313
Country	:	US
Telephone Number	:	512-452-3100
Fax Number	:	512-452-3200

Provider Business Practice Location Address
First Line	:	4409 MEDICAL PKWY
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-3313
Country	:	US
Telephone Number	:	512-452-3100
Fax Number	:	512-452-3200

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2007
Last Update Date	:	07/21/2022

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