Provider Demographics
NPI:1386825107
Name:TERESA PARTIN MORTON OD P S C
Entity Type:Organization
Organization Name:TERESA PARTIN MORTON OD P S C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:PARTIN
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:606-843-6060
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:40729-0548
Practice Address - Country:US
Practice Address - Phone:606-843-6060
Practice Address - Fax:606-843-7243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1270DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7701-2706Medicaid
KY000000051211OtherANTHEM
KY1499379OtherUMWA
KY7517OtherCHA
KY=========OtherHUMANA
KY=========OtherTRICARE SOUTH
KY7701-2706Medicaid
KY7517OtherCHA
KY1499379OtherUMWA
KY7701-2706Medicaid
KY=========OtherUNITED HEALTH CARE
KY=========OtherTRICARE SOUTH