Provider Demographics
NPI:1366505992
Name:MORTON, TERESA PARTIN (OD PSC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:PARTIN
Last Name:MORTON
Suffix:
Gender:F
Credentials:OD PSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:
Mailing Address - City:EAST BERNSTADT
Mailing Address - State:KY
Mailing Address - Zip Code:40729-0548
Mailing Address - Country:US
Mailing Address - Phone:606-843-6060
Mailing Address - Fax:606-843-7243
Practice Address - Street 1:2647 N US HWY 25
Practice Address - Street 2:
Practice Address - City:EAST BERNSTADT
Practice Address - State:KY
Practice Address - Zip Code:40729
Practice Address - Country:US
Practice Address - Phone:606-843-6060
Practice Address - Fax:606-843-7243
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY1270152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7517OtherCHA
KY611284674OtherHUMANA
KY1499379OtherUMWA
KY000000051211OtherANTHEM
KY611284674OtherBLUEGRASS FAMILY HEALTH
KY611284674OtherTRICARE SOUTH
KY77012706Medicaid
410028137Medicare PIN
1054140001Medicare NSC
KY000000051211OtherANTHEM
KY611284674OtherHUMANA