Provider Demographics
NPI:1306825393
Name:TESSMAN, CHARLES M SR (OD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:M
Last Name:TESSMAN
Suffix:SR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 WILTON RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938-6128
Mailing Address - Country:US
Mailing Address - Phone:207-249-8449
Mailing Address - Fax:
Practice Address - Street 1:334 HIGHWAY 92 S STE 7
Practice Address - Street 2:
Practice Address - City:DANDRIDGE
Practice Address - State:TN
Practice Address - Zip Code:37725-4578
Practice Address - Country:US
Practice Address - Phone:865-397-9991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT880152W00000X
TN3641152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME132650100Medicaid
ME132650100Medicaid