Provider Demographics
NPI:1073807962
Name:SAMUEL J TESKE OD PA
Entity Type:Organization
Organization Name:SAMUEL J TESKE OD PA
Other - Org Name:THE EYE DOCTORS OF NEW TAMPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TESKE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:813-632-2020
Mailing Address - Street 1:19070 BRUCE B DOWNS BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2477
Mailing Address - Country:US
Mailing Address - Phone:813-632-2020
Mailing Address - Fax:813-631-9802
Practice Address - Street 1:19070 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2477
Practice Address - Country:US
Practice Address - Phone:813-632-2020
Practice Address - Fax:813-631-9802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-08
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3764152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty