Provider Demographics
NPI:1063739548
Name:TERESA A MAYHEW-SUTHERLAND
Entity type:Organization
Organization Name:TERESA A MAYHEW-SUTHERLAND
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAYHEW
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:805-684-5476
Mailing Address - Street 1:5434 CARPINTERIA AVE
Mailing Address - Street 2:
Mailing Address - City:CARPINTERIA
Mailing Address - State:CA
Mailing Address - Zip Code:93013-1423
Mailing Address - Country:US
Mailing Address - Phone:805-684-5476
Mailing Address - Fax:805-684-5477
Practice Address - Street 1:5434 CARPINTERIA AVE
Practice Address - Street 2:
Practice Address - City:CARPINTERIA
Practice Address - State:CA
Practice Address - Zip Code:93013-1423
Practice Address - Country:US
Practice Address - Phone:805-684-5476
Practice Address - Fax:805-684-5477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8802T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1265404180OtherPERSONAL NPI
CASD0088020Medicaid
CA1125710001Medicare NSC
CASD0088020Medicaid