Provider Demographics
NPI:1134725609
Name:TEI-WAKE FOREST OD PLLC
Entity type:Organization
Organization Name:TEI-WAKE FOREST OD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUEVARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-648-2750
Mailing Address - Street 1:742 MCKNIGHT DR STE 100
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-7764
Mailing Address - Country:US
Mailing Address - Phone:919-266-2048
Mailing Address - Fax:919-266-4648
Practice Address - Street 1:3211 ROGERS RD STE 100
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-3891
Practice Address - Country:US
Practice Address - Phone:919-453-1220
Practice Address - Fax:919-453-1221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-09
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty