MEDICARE: DR. PATRICIA LYNN BAILEY 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	OP0003121	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1942351218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA LYNN BAILEY O.D.

Provider Business Mailing Address
First Line	:	234 SW SCOTT PL
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32024-3897
Country	:	US
Telephone Number	:	386-965-5205
Fax Number	:	386-330-2592

Provider Business Practice Location Address
First Line	:	2469 W US HIGHWAY 90 # A-27
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-4738
Country	:	US
Telephone Number	:	386-515-8647
Fax Number	:	386-361-7819

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

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	08/25/2021

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