Provider Demographics
NPI:1316006620
Name:TEEPLE, REX G (OD)
Entity Type:Individual
Prefix:DR
First Name:REX
Middle Name:G
Last Name:TEEPLE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9795 CROSSPOINT BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3354
Mailing Address - Country:US
Mailing Address - Phone:317-254-6480
Mailing Address - Fax:317-259-8609
Practice Address - Street 1:1921 E. 53RD STREET
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46013-4029
Practice Address - Country:US
Practice Address - Phone:765-649-2278
Practice Address - Fax:317-259-8609
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001679B152W00000X
IN18001679A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN20091414970Medicaid
IN200914970BMedicaid
IN894060XMedicare PIN
IN200914970BMedicaid
INT34886Medicare UPIN