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General NPI Number Information
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NPI Number | 1740695295
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Entity Type | Individual
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Provider Name | REENA PATRO O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/24/2014
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Last Update Date | 04/13/2021
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Provider Practice Location Address
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Address Line | 106 DRYDEN RD
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City | ITHACA
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State | NY
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Zip | 14850
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Country | US
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Telephone | 607-273-1234
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Fax |
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Provider Business Mailing Address
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Address Line | 131 E GREEN ST APT 415
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City | ITHACA
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State | NY
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Zip | 14850-5657
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Country | US
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Telephone | 972-365-6595
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 8463T
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV009240
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License Number State | NY
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