Provider Demographics
NPI:1851753149
Name:TERAUCHI, AIMEE (OD, PHD)
Entity Type:Individual
Prefix:DR
First Name:AIMEE
Middle Name:
Last Name:TERAUCHI
Suffix:
Gender:F
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 1:3984 E AZALEA DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-0604
Mailing Address - Country:US
Mailing Address - Phone:510-290-1583
Mailing Address - Fax:
Practice Address - Street 1:5290 S POWER RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-8478
Practice Address - Country:US
Practice Address - Phone:480-988-9287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-24
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2103152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist