Provider Demographics
NPI:1891796314
Name:BARKER-SUTTON, TESHAWNA (OD)
Entity Type:Individual
Prefix:
First Name:TESHAWNA
Middle Name:
Last Name:BARKER-SUTTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 CHERA LYNN ST
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-3142
Mailing Address - Country:US
Mailing Address - Phone:606-878-7500
Mailing Address - Fax:606-878-8005
Practice Address - Street 1:930 E 4TH ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-2521
Practice Address - Country:US
Practice Address - Phone:606-878-7500
Practice Address - Fax:606-878-8005
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1541DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77000834Medicaid
KY0444900001Medicare NSC
KY77000834Medicaid
1943501Medicare PIN