Provider Demographics
NPI:1598777179
Name:HUNG, TERI D (OD)
Entity type:Individual
Prefix:DR
First Name:TERI
Middle Name:D
Last Name:HUNG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8400 HOLCOMB BRIDGE RD
Mailing Address - Street 2:SUITE 440
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-1837
Mailing Address - Country:US
Mailing Address - Phone:770-645-1222
Mailing Address - Fax:770-645-1210
Practice Address - Street 1:8400 HOLCOMB BRIDGE RD
Practice Address - Street 2:SUITE 440
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-1837
Practice Address - Country:US
Practice Address - Phone:770-645-1222
Practice Address - Fax:770-645-1210
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA1946152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU93385Medicare UPIN
GA41ZCGBJMedicare ID - Type Unspecified