Provider Demographics
NPI:1528189966
Name:BAYDOWICZ, TERESA ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:ANN
Last Name:BAYDOWICZ
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 1:201 W PONCE DE LEON AVE
Mailing Address - Street 2:#218
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3270
Mailing Address - Country:US
Mailing Address - Phone:678-862-2153
Mailing Address - Fax:
Practice Address - Street 1:3337 BUFORD HWY NE
Practice Address - Street 2:34-B
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-1709
Practice Address - Country:US
Practice Address - Phone:404-486-8901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002166152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist