Provider Demographics
NPI:1417987496
Name:TESKA, LYLE R (MD)
Entity Type:Individual
Prefix:DR
First Name:LYLE
Middle Name:R
Last Name:TESKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 W CAMPBELL RD STE 400
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3636
Mailing Address - Country:US
Mailing Address - Phone:972-690-1990
Mailing Address - Fax:972-690-5262
Practice Address - Street 1:399 W CAMPBELL RD STE 400
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3636
Practice Address - Country:US
Practice Address - Phone:972-690-1990
Practice Address - Fax:972-690-5262
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5016207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG68917Medicare UPIN
TX8F2071Medicare PIN