Provider Demographics
NPI:1871632406
Name:TEAGLE, ROBERT HAROLD JR (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:HAROLD
Last Name:TEAGLE
Suffix:JR
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 1:27011 MCBEAN PKWY STE 107
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-5148
Mailing Address - Country:US
Mailing Address - Phone:661-253-3888
Mailing Address - Fax:661-253-4096
Practice Address - Street 1:27011 MCBEAN PKWY STE 107
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5148
Practice Address - Country:US
Practice Address - Phone:661-253-3888
Practice Address - Fax:661-253-4096
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9104T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist