Provider Demographics
NPI:1346377231
Name:TEETS, KRISTIE L (OD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIE
Middle Name:L
Last Name:TEETS
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 1:825 FISHBURN RD
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-2015
Mailing Address - Country:US
Mailing Address - Phone:717-533-5200
Mailing Address - Fax:717-533-2606
Practice Address - Street 1:825 FISHBURN RD
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2015
Practice Address - Country:US
Practice Address - Phone:717-533-5200
Practice Address - Fax:717-533-2606
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12783 T152W00000X
PAOEG001656152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist