Provider Demographics
NPI:1598739302
Name:KENT, THERESA SUZANNE (OD)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:SUZANNE
Last Name:KENT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:THERESA
Other - Middle Name:SUZANNE
Other - Last Name:ORENCHAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:9725 DATAPOINT DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-2384
Mailing Address - Country:US
Mailing Address - Phone:210-930-8165
Mailing Address - Fax:
Practice Address - Street 1:9725 DATAPOINT DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-2384
Practice Address - Country:US
Practice Address - Phone:210-930-8165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE005031T152W00000X
NJ27OA00363700152W00000X
FLOP 1421152W00000X
TX07150T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist