Provider Demographics
NPI:1205090750
Name:METZING, TESSA R (OD)
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:R
Last Name:METZING
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:TESSA
Other - Middle Name:R
Other - Last Name:SCHLICKBERND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 EDWARDS DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-5680
Mailing Address - Country:US
Mailing Address - Phone:317-839-2368
Mailing Address - Fax:317-839-1267
Practice Address - Street 1:1855 STAFFORD RD
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-2338
Practice Address - Country:US
Practice Address - Phone:317-839-2368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003572AB152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist