Healthcare Provider Details

I. General information

NPI: 1306825393
Provider Name (Legal Business Name): CHARLES M TESSMAN SR. OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 S MOUNT AUBURN RD
CAPE GIRARDEAU MO
63703-6387
US

IV. Provider business mailing address

711 S MOUNT AUBURN RD
CAPE GIRARDEAU MO
63703-6387
US

V. Phone/Fax

Practice location:
  • Phone: 573-686-4151
  • Fax:
Mailing address:
  • Phone: 573-686-4151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3641
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: