MEDICARE: C J PATALUCH OD PC

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	152W00000X	Optometrist	18002539B	IN

General Provider Information

NPI Number	:	1760786503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C J PATALUCH OD PC

Provider Business Mailing Address
First Line	:	5659 COVENTRY LN
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-7145
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6709 W JEFFERSON BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-6209
Country	:	US
Telephone Number	:	765-617-1890
Fax Number	:	260-432-8506

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHRISTOPHER PATALUCH
Credential	:	OD
Telephone Number	:	260-432-8409

Provider Enumeration Date	:	01/10/2011
Last Update Date	:	07/26/2022

Similar Medicare Providers

1154480911 — CHRISTINA TAN MICHELLE KENNEDY O.D.
Practice Location Address:

6709 W JEFFERSON BLVD
FORT WAYNE, IN
46804-6209

Practice Phone: 260-432-8409
Practice Fax: 260-484-0616

1518202431 — LONGE ENTERPRISES CORP
Practice Location Address:

6709 W JEFFERSON BLVD
FORT WAYNE, IN
46804-6209

Practice Phone: 260-432-8409
Practice Fax:

1245363241 — MR. BRIAN ANTHONY SORBELLO L.M.T.
Practice Location Address:

823 LAKE MCGREGOR DR
FORT MYERS, FL
33919-6209

Practice Phone: 239-443-8205
Practice Fax:

1841314747 — MS. ROSITA HERODEK LMT
Practice Location Address:

823 LAKE MCGREGOR DR
FORT MYERS, FL
33919-6209

Practice Phone: 239-357-8442
Practice Fax:

1699988394 — ANGELINE BAZELAIS
Practice Location Address:

802 HOLLY AVE
FORT PIERCE, FL
34982-6209

Practice Phone: 772-460-4791
Practice Fax:

1497034995 — BRADLEY MICHAEL SMITH A.T.P.
Practice Location Address:

6209 TRAIL LAKE DR
FORT WORTH, TX
76133-3405

Practice Phone: 817-793-3773
Practice Fax:

Directions to “C J PATALUCH OD PC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.