Provider Demographics
NPI:1962562983
Name:GIESKE, TERRI ANN (O D)
Entity type:Individual
Prefix:DR
First Name:TERRI
Middle Name:ANN
Last Name:GIESKE
Suffix:
Gender:F
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6239 E BROWN RD
Mailing Address - Street 2:STE 113
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-4933
Mailing Address - Country:US
Mailing Address - Phone:480-386-5118
Mailing Address - Fax:
Practice Address - Street 1:6239 E BROWN RD
Practice Address - Street 2:STE 113
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-4933
Practice Address - Country:US
Practice Address - Phone:480-218-0663
Practice Address - Fax:480-324-1494
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ773152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ861006141OtherTAX ID
AZU09398Medicare UPIN