Provider Demographics
NPI:1992497580
Name:SMALL, TERI LYNNE
Entity type:Individual
Prefix:
First Name:TERI
Middle Name:LYNNE
Last Name:SMALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 FURR ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-9500
Mailing Address - Country:US
Mailing Address - Phone:434-447-2777
Mailing Address - Fax:434-447-2908
Practice Address - Street 1:315 FURR ST
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-9500
Practice Address - Country:US
Practice Address - Phone:434-447-2777
Practice Address - Fax:434-447-2908
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101003741156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician