Provider Demographics
NPI:1700954351
Name:SHERRIE D TEDDY ODPA
Entity Type:Organization
Organization Name:SHERRIE D TEDDY ODPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:TEDDY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:727-372-0414
Mailing Address - Street 1:2740 SEVEN SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-3623
Mailing Address - Country:US
Mailing Address - Phone:727-372-0414
Mailing Address - Fax:727-372-9313
Practice Address - Street 1:2740 SEVEN SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-3623
Practice Address - Country:US
Practice Address - Phone:727-372-0414
Practice Address - Fax:727-372-9313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1797152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0482470001OtherP TAN