Provider Demographics
NPI:1700446135
Name:WEBER, TEA (OD)
Entity Type:Individual
Prefix:DR
First Name:TEA
Middle Name:
Last Name:WEBER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:TEA
Other - Middle Name:
Other - Last Name:PASHOLLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:2075 S WILLOW ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-2305
Practice Address - Country:US
Practice Address - Phone:603-644-6100
Practice Address - Fax:603-644-6100
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH999152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist