=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750362133
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY HSU PATEK O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2005
-----------------------------------------------------
Last Update Date | 09/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1850 N ZARAGOZA RD
-----------------------------------------------------
City | EL PASO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79936-7911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-581-4497
-----------------------------------------------------
Fax | 818-238-0252
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 413 ROCKY POINTE DR
-----------------------------------------------------
City | EL PASO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-688-6341
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 11655TPL
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 7856T
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------