Provider Demographics
NPI:1619124948
Name:OSBORNE, TERESA ANN
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:ANN
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13520 HIGHWAY 119 S
Mailing Address - Street 2:
Mailing Address - City:PARTRIDGE
Mailing Address - State:KY
Mailing Address - Zip Code:40862-6417
Mailing Address - Country:US
Mailing Address - Phone:606-589-4586
Mailing Address - Fax:606-589-5930
Practice Address - Street 1:13520 HIGHWAY 119 S
Practice Address - Street 2:
Practice Address - City:PARTRIDGE
Practice Address - State:KY
Practice Address - Zip Code:40862-6417
Practice Address - Country:US
Practice Address - Phone:606-589-4586
Practice Address - Fax:606-589-5930
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY156F00000X
KY4207156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist