Healthcare Provider Details

I. General information

NPI: 1063739548
Provider Name (Legal Business Name): TERESA A MAYHEW-SUTHERLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 07/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5434 CARPINTERIA AVE
CARPINTERIA CA
93013-1423
US

IV. Provider business mailing address

5434 CARPINTERIA AVE
CARPINTERIA CA
93013-1423
US

V. Phone/Fax

Practice location:
  • Phone: 805-684-5476
  • Fax: 805-684-5477
Mailing address:
  • Phone: 805-684-5476
  • Fax: 805-684-5477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number8802T
License Number StateCA

VIII. Authorized Official

Name: DR. TERESA A MAYHEW
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 805-684-5476