Provider Demographics
NPI:1609080902
Name:TEASTER OPTICAL
Entity Type:Organization
Organization Name:TEASTER OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:Y
Authorized Official - Last Name:BENEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-396-2440
Mailing Address - Street 1:3426 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-7319
Mailing Address - Country:US
Mailing Address - Phone:318-396-2440
Mailing Address - Fax:318-397-2328
Practice Address - Street 1:3426 CYPRESS ST
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-7319
Practice Address - Country:US
Practice Address - Phone:318-396-2440
Practice Address - Fax:318-397-2328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4905469-001332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier