Healthcare Provider Details

I. General information

NPI: 1104496538
Provider Name (Legal Business Name): HEIDI KRISTINE TEDRICK OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEIDI KRISTINE NELSON

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 S BAY RD
DOVER DE
19901-4615
US

IV. Provider business mailing address

1601 KIRKWOOD HWY
WILMINGTON DE
19805-4917
US

V. Phone/Fax

Practice location:
  • Phone: 302-994-2511
  • Fax: 302-633-5385
Mailing address:
  • Phone: 302-994-2511
  • Fax: 302-633-5358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberI3-0011441
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: