Provider Demographics
NPI:1598079451
Name:TEAGUE, KRISTEN D (OD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:D
Last Name:TEAGUE
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:PO BOX 953
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:AR
Mailing Address - Zip Code:71711-0953
Mailing Address - Country:US
Mailing Address - Phone:870-836-7319
Mailing Address - Fax:870-836-7310
Practice Address - Street 1:1421 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701-4507
Practice Address - Country:US
Practice Address - Phone:870-836-7319
Practice Address - Fax:870-836-7310
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2655152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist