Provider Demographics
NPI:1891896072
Name:TEAGUE EYE CARE CENTER PA
Entity Type:Organization
Organization Name:TEAGUE EYE CARE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AUDIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:TEAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:870-836-7319
Mailing Address - Street 1:PO BOX 953
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:AR
Mailing Address - Zip Code:71711-0953
Mailing Address - Country:US
Mailing Address - Phone:870-836-7319
Mailing Address - Fax:870-836-7310
Practice Address - Street 1:1421 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701-4507
Practice Address - Country:US
Practice Address - Phone:870-836-7319
Practice Address - Fax:870-836-7310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2325152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR161690722Medicaid
AR5632710001OtherDME
ARDE4369OtherRAILROAD MEDICARE
AR5632710001Medicare NSC
AR161690722Medicaid