Healthcare Provider Details

I. General information

NPI: 1871534768
Provider Name (Legal Business Name): LAURA FAITH PATTERSON O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA FAITH BOLENBAKER O.D.

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 08/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10459 DOUBLE R BLVD
RENO NV
89521-8905
US

IV. Provider business mailing address

5961 LOS ALTOS PKWY STE. 101
SPARKS NV
89436-2500
US

V. Phone/Fax

Practice location:
  • Phone: 775-827-3030
  • Fax: 775-827-5479
Mailing address:
  • Phone: 775-359-2020
  • Fax: 775-359-2676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0528
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: