Provider Demographics
NPI:1215966338
Name:DESCHENES, THERESE C (OD)
Entity type:Individual
Prefix:DR
First Name:THERESE
Middle Name:C
Last Name:DESCHENES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 W GERMANTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:TROOPER
Mailing Address - State:PA
Mailing Address - Zip Code:19403-1037
Mailing Address - Country:US
Mailing Address - Phone:610-630-6633
Mailing Address - Fax:610-630-8539
Practice Address - Street 1:2900 W GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:TROOPER
Practice Address - State:PA
Practice Address - Zip Code:19403-1037
Practice Address - Country:US
Practice Address - Phone:610-630-6633
Practice Address - Fax:610-630-8539
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE006871-T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA410027793Medicare PIN
PA634063XZKMedicare PIN
PAU08331Medicare UPIN