Provider Demographics
NPI:1982649349
Name:TEIG, GARY ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:ALAN
Last Name:TEIG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 2ND AVE SE
Mailing Address - Street 2:STE. B
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-2460
Mailing Address - Country:US
Mailing Address - Phone:319-365-8621
Mailing Address - Fax:
Practice Address - Street 1:860 2ND AVE SE
Practice Address - Street 2:STE. B
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2460
Practice Address - Country:US
Practice Address - Phone:319-365-8621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1570152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0040170Medicaid
IA07579OtherBLUE CROSS, BLUE SHIELD
IA07579OtherBLUE CROSS, BLUE SHIELD
IA07579Medicare ID - Type Unspecified
IA4470400001Medicare NSC