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General NPI Number Information
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NPI Number | 1669656799
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Entity Type | Organization
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Legal Business Name | PATMICK LLC
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Dates
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Enumeration Date | 12/26/2007
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Last Update Date | 07/27/2017
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Provider Practice Location Address
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Address Line | 2255 8TH AVE
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City | FORT WORTH
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State | TX
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Zip | 76110-1812
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Country | US
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Telephone | 817-370-6118
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Fax | 817-370-7118
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Provider Business Mailing Address
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Address Line | 2255 8TH AVE
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City | FORT WORTH
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State | TX
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Zip | 76110-1812
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Country | US
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Telephone | 817-370-6118
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Fax | 817-370-7118
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Authorized Official
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Title or Position | PRINCIPAL
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Name | MR. MICHAEL JACK BRADLEY
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Credential |
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Telephone | 817-370-6118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | DRO166
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License Number State | TX
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