Provider Demographics
NPI:1891361978
Name:DONALD E. TEAGLE OPTOMETRIC CORPORATION
Entity Type:Organization
Organization Name:DONALD E. TEAGLE OPTOMETRIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:TEAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:818-956-0873
Mailing Address - Street 1:1306 GLENDALE GALLERIA
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91210-1400
Mailing Address - Country:US
Mailing Address - Phone:818-956-0873
Mailing Address - Fax:818-956-1307
Practice Address - Street 1:1306 GLENDALE GALLERIA
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91210-1400
Practice Address - Country:US
Practice Address - Phone:818-956-0873
Practice Address - Fax:818-956-1307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-31
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty