Healthcare Provider Details

I. General information

NPI: 1306944814
Provider Name (Legal Business Name): DONALD ROY TESHIMA O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

947 S ANAHEIM BLVD SUITE 120
ANAHEIM CA
92805-5582
US

IV. Provider business mailing address

888 S DISNEYLAND DR SUITE 100
ANAHEIM CA
92802-1847
US

V. Phone/Fax

Practice location:
  • Phone: 714-821-4666
  • Fax: 714-533-6800
Mailing address:
  • Phone: 714-399-0678
  • Fax: 714-276-6489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT5954TPA
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: