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: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 HIGHWAY 92 S STE 7
DANDRIDGE TN
37725-4578
US

IV. Provider business mailing address

615 WILTON RD
FARMINGTON ME
04938-6128
US

V. Phone/Fax

Practice location:
  • Phone: 865-397-9991
  • Fax:
Mailing address:
  • Phone: 207-249-8449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT880
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3641
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: