Provider Demographics
NPI:1093899759
Name:NEMETH, THERESA M (OD)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:NEMETH
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 1:3539 GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614
Mailing Address - Country:US
Mailing Address - Phone:419-385-7575
Mailing Address - Fax:419-385-4531
Practice Address - Street 1:3539 GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614
Practice Address - Country:US
Practice Address - Phone:419-385-7575
Practice Address - Fax:419-385-4531
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3816152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0680231Medicaid
NE0604421Medicare PIN
TH9266361Medicare ID - Type UnspecifiedGROUP
OH0680231Medicaid
0189340001Medicare NSC