Provider Demographics
NPI:1235820259
Name:LEEPER, TERESA (LICENSED OPTICIAN)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:LEEPER
Suffix:
Gender:F
Credentials:LICENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 WARDS RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-2942
Mailing Address - Country:US
Mailing Address - Phone:434-832-1208
Mailing Address - Fax:434-832-0466
Practice Address - Street 1:3900 WARDS RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-2942
Practice Address - Country:US
Practice Address - Phone:434-832-1208
Practice Address - Fax:434-832-0466
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101002861156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician