Provider Demographics
NPI:1265574917
Name:TEATHER, THOMAS C (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:C
Last Name:TEATHER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1478 HIGHLAND AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-6501
Mailing Address - Country:US
Mailing Address - Phone:321-242-2029
Mailing Address - Fax:321-242-2423
Practice Address - Street 1:1478 HIGHLAND AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-6501
Practice Address - Country:US
Practice Address - Phone:321-242-2029
Practice Address - Fax:321-242-2423
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2013-10-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME66195207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375920200Medicaid
25575Medicare PIN
FLF87713Medicare UPIN