Provider Demographics
NPI:1043380439
Name:DO, TERESA XUAN (OD)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:XUAN
Last Name:DO
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 1:500 S EUCLID ST STE D
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92802-1251
Mailing Address - Country:US
Mailing Address - Phone:714-635-1100
Mailing Address - Fax:714-635-1155
Practice Address - Street 1:500 S EUCLID ST STE D
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-1251
Practice Address - Country:US
Practice Address - Phone:714-635-1100
Practice Address - Fax:714-635-1155
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12291T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABZ343YMedicare PIN