Provider Demographics
NPI:1922081454
Name:SETLOCK, THERESA M (OD)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:M
Last Name:SETLOCK
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 1:11080 N POINSETTIA DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-9564
Mailing Address - Country:US
Mailing Address - Phone:520-797-0244
Mailing Address - Fax:
Practice Address - Street 1:6987 N ORACLE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-4224
Practice Address - Country:US
Practice Address - Phone:520-297-2501
Practice Address - Fax:520-297-9496
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ753152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ049272Medicaid
U17396Medicare UPIN
AZ102599Medicare ID - Type Unspecified
AZ102600Medicare ID - Type Unspecified