Provider Demographics
NPI:1982710273
Name:TESINSKY, CECILIA WONG (OD)
Entity Type:Individual
Prefix:DR
First Name:CECILIA
Middle Name:WONG
Last Name:TESINSKY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12001 AVALON LAKE DR
Mailing Address - Street 2:SUITE J
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7375
Mailing Address - Country:US
Mailing Address - Phone:407-567-9955
Mailing Address - Fax:
Practice Address - Street 1:12001 AVALON LAKE DR
Practice Address - Street 2:SUITE J
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7375
Practice Address - Country:US
Practice Address - Phone:407-567-9955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3843152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCN261ZMedicare PIN