=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023074085
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICK EDWARD PADRNOS O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2006
-----------------------------------------------------
Last Update Date | 10/13/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1135 S PLAZA WAY
-----------------------------------------------------
City | FLAGSTAFF
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86001-6317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-779-5600
-----------------------------------------------------
Fax | 928-779-5701
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1135 S PLAZA WAY
-----------------------------------------------------
City | FLAGSTAFF
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86001-6317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-779-5600
-----------------------------------------------------
Fax | 928-779-5701
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 646
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------