Provider Demographics
NPI:1710270103
Name:SAM TESKE OD PA
Entity Type:Organization
Organization Name:SAM TESKE OD PA
Other - Org Name:THE EYE DOCTORS OF TRINITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WHALEY
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:813-632-2020
Mailing Address - Street 1:2740 SEVEN SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-3623
Mailing Address - Country:US
Mailing Address - Phone:727-372-2020
Mailing Address - Fax:727-372-9313
Practice Address - Street 1:2740 SEVEN SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-3623
Practice Address - Country:US
Practice Address - Phone:727-372-2020
Practice Address - Fax:727-372-9313
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAMUEL J TESKE OD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-18
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3764152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty