Provider Demographics
NPI:1790737161
Name:DR TERESA ENNIS-DECKER & ASSOCIATES
Entity Type:Organization
Organization Name:DR TERESA ENNIS-DECKER & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:ENNIS-DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:989-871-3559
Mailing Address - Street 1:7925 SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48746-9619
Mailing Address - Country:US
Mailing Address - Phone:989-871-3559
Mailing Address - Fax:
Practice Address - Street 1:4313 CORUNNA RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-4152
Practice Address - Country:US
Practice Address - Phone:810-733-5544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003316152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty