Provider Demographics
NPI:1659560621
Name:TELES, MAYER JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:MAYER
Middle Name:JOSEPH
Last Name:TELES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8028 RITCHIE HWY
Mailing Address - Street 2:SUITE 124
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-1075
Mailing Address - Country:US
Mailing Address - Phone:410-768-0202
Mailing Address - Fax:410-768-1330
Practice Address - Street 1:8028 RITCHIE HWY
Practice Address - Street 2:SUITE 124
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-1075
Practice Address - Country:US
Practice Address - Phone:410-768-0202
Practice Address - Fax:410-768-1330
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA0974152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT1680001OtherCAREFIRST BLUECHOICE
MD603673OtherAETNA
MDKEN4LOOtherBCBS OF MARYLAND
MDT1680001OtherBCBS FEDERAL EMPLOYEES
MD774FMedicare PIN
MDT1680001OtherBCBS FEDERAL EMPLOYEES