Provider Demographics
NPI:1871534768
Name:PATTERSON, LAURA FAITH (OD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:FAITH
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:FAITH
Other - Last Name:BOLENBAKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:5961 LOS ALTOS PKWY
Mailing Address - Street 2:STE. 101
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-2500
Mailing Address - Country:US
Mailing Address - Phone:775-359-2020
Mailing Address - Fax:775-359-2676
Practice Address - Street 1:10459 DOUBLE R BLVD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-8905
Practice Address - Country:US
Practice Address - Phone:775-827-3030
Practice Address - Fax:775-827-5479
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0528152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV4682730001Medicare NSC
NVV12258Medicare UPIN
NVV37415Medicare PIN
NVAU179ZMedicare PIN