MEDICARE: DR. CAREY A PATRICK OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WC0802X	Corneal and Contact Management Optometrist	6243TG	TX
2	152WP0200X	Pediatric Optometrist	6243TG	TX
3	152WS0006X	Sports Vision Optometrist	6243TG	TX
4	152W00000X	Optometrist	06243TG	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11411072	OTHER		CAQH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104824242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAREY A PATRICK OD

Provider Business Mailing Address
First Line	:	1546 STACY RD
Second Line	:	SUITE 100
City	:	ALLEN
State	:	TX
Zip	:	75002-8726
Country	:	US
Telephone Number	:	214-383-5400
Fax Number	:	214-383-5203

Provider Business Practice Location Address
First Line	:	1546 STACY RD
Second Line	:	SUITE 100
City	:	ALLEN
State	:	TX
Zip	:	75002-8726
Country	:	US
Telephone Number	:	214-383-5400
Fax Number	:	214-383-5203

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	01/28/2014

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