MEDICARE: ELIZABETH PATTEN HITCHCOCK O.D.

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	761	MS
2	152W00000X	Optometrist	R-197-TA-878	AL

General Provider Information

NPI Number	:	1932399375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH PATTEN HITCHCOCK O.D.

Provider Business Mailing Address
First Line	:	401 W ORANGE ST
Second Line	:
City	:	TROY
State	:	AL
Zip	:	36081-2316
Country	:	US
Telephone Number	:	205-516-6628
Fax Number	:

Provider Business Practice Location Address
First Line	:	1420 HIGHWAY 231 S
Second Line	:
City	:	TROY
State	:	AL
Zip	:	36081-2504
Country	:	US
Telephone Number	:	334-566-1551
Fax Number	:

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

Provider Enumeration Date	:	08/01/2007
Last Update Date	:	03/02/2017

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