Provider Demographics
NPI:1922289305
Name:THERESE C. DESCHENES, OD; PC
Entity Type:Organization
Organization Name:THERESE C. DESCHENES, OD; PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESE
Authorized Official - Middle Name:CECELIA
Authorized Official - Last Name:DESCHENES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-630-6633
Mailing Address - Street 1:2900 W GERMANTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:TROOPER
Mailing Address - State:PA
Mailing Address - Zip Code:19403-1037
Mailing Address - Country:US
Mailing Address - Phone:610-630-6633
Mailing Address - Fax:610-630-8539
Practice Address - Street 1:2900 W GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:TROOPER
Practice Address - State:PA
Practice Address - Zip Code:19403-1037
Practice Address - Country:US
Practice Address - Phone:610-630-6633
Practice Address - Fax:610-630-8539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE006871-T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0478280001Medicare NSC
PADN5606Medicare PIN
PAU08331Medicare UPIN
PA122239Medicare PIN