Provider Demographics
NPI:1679609382
Name:TEVIS, TROY NATHANIEL (OD, PHD)
Entity Type:Individual
Prefix:MR
First Name:TROY
Middle Name:NATHANIEL
Last Name:TEVIS
Suffix:
Gender:M
Credentials:OD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORDTON
Mailing Address - State:NC
Mailing Address - Zip Code:28139-2505
Mailing Address - Country:US
Mailing Address - Phone:828-288-8662
Mailing Address - Fax:828-288-4882
Practice Address - Street 1:337 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139-2505
Practice Address - Country:US
Practice Address - Phone:828-288-8662
Practice Address - Fax:828-288-4882
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1807152W00000X, 152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89093AFMedicaid
NC24491OtherOPTICARE
NCNC1807OtherSTATE LIC
NC0313616OtherCIGNA
NC71877OtherMEDCOST
NC093AFOtherBLUECROSS BLUESHIELD
NC71877OtherMEDCOST
NCU82788Medicare UPIN
NC093AFOtherBLUECROSS BLUESHIELD
NC0313616OtherCIGNA