Healthcare Provider Details

I. General information

NPI: 1629078050
Provider Name (Legal Business Name): TERESA M TAYLOR O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date: 03/22/2006
Reactivation Date: 04/24/2006

III. Provider practice location address

7075 N SHARON AVE
FRESNO CA
93720-3329
US

IV. Provider business mailing address

7075 N SHARON AVE STE 102
FRESNO CA
93720-3329
US

V. Phone/Fax

Practice location:
  • Phone: 559-486-2000
  • Fax:
Mailing address:
  • Phone: 559-486-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT2576
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number398T
License Number StateWY
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTLG35369
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: