Healthcare Provider Details

I. General information

NPI: 1942138193
Provider Name (Legal Business Name): TESS D ABBOTT OPTICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N MAIN ST
SUFFOLK VA
23434-4321
US

IV. Provider business mailing address

601 GLADSTONE AVE
PORTSMOUTH VA
23701-1113
US

V. Phone/Fax

Practice location:
  • Phone: 757-925-0477
  • Fax: 757-538-0745
Mailing address:
  • Phone: 757-372-5342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number1101003959
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: