Provider Demographics
NPI:1194413146
Name:TEI- DAVIDSON OD
Entity type:Organization
Organization Name:TEI- DAVIDSON OD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUEVARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-397-4333
Mailing Address - Street 1:742 MCKNIGHT DR STE 100
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-7764
Mailing Address - Country:US
Mailing Address - Phone:919-266-2048
Mailing Address - Fax:
Practice Address - Street 1:610 JETTON ST STE 140
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-0029
Practice Address - Country:US
Practice Address - Phone:704-997-8199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE EYE INSTITUTE OD, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-27
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty