Provider Demographics
NPI:1992895874
Name:TEICHMILLER, CHRIS DEWAYNE (O D)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:DEWAYNE
Last Name:TEICHMILLER
Suffix:
Gender:M
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 1:823 6TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-3021
Mailing Address - Country:US
Mailing Address - Phone:256-353-1871
Mailing Address - Fax:256-350-2140
Practice Address - Street 1:823 6TH AVE SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3021
Practice Address - Country:US
Practice Address - Phone:256-353-1871
Practice Address - Fax:256-350-2140
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS718TA087152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051503954Medicaid
ALU01144Medicare UPIN
AL051503954Medicaid