Provider Demographics
NPI:1376514976
Name:TEIGEN, GENE O (OD)
Entity Type:Individual
Prefix:
First Name:GENE
Middle Name:O
Last Name:TEIGEN
Suffix:
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 1:11614 N ALBERTA LN
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-2607
Mailing Address - Country:US
Mailing Address - Phone:509-467-3219
Mailing Address - Fax:
Practice Address - Street 1:9671 N NEVADA ST
Practice Address - Street 2:SUITE 210
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1146
Practice Address - Country:US
Practice Address - Phone:509-468-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001023152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2004398Medicaid
WA2004398Medicaid
WAAB09334Medicare ID - Type Unspecified