Provider Demographics
NPI:1851467682
Name:TESSIN, DAVID EDWARD (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:EDWARD
Last Name:TESSIN
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 1:105 BONNIE LN
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-9220
Mailing Address - Country:US
Mailing Address - Phone:814-696-9459
Mailing Address - Fax:
Practice Address - Street 1:1902 N JUNIATA ST
Practice Address - Street 2:
Practice Address - City:HOLLIDAYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16648-1908
Practice Address - Country:US
Practice Address - Phone:814-693-6606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001549152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU11149Medicare UPIN
PATE1542209Medicare ID - Type Unspecified