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General NPI Number Information
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NPI Number | 1154124774
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Entity Type | Individual
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Provider Name | KYLA TESKE ABOC, NCLEC, LDO
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Gender | Female
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Dates
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Enumeration Date | 03/29/2025
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Last Update Date | 03/29/2025
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Provider Practice Location Address
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Address Line | 12900 W THUNDERBIRD RD
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City | EL MIRAGE
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State | AZ
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Zip | 85335-5945
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Country | US
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Telephone | 623-583-8920
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Fax | 623-583-8979
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Provider Business Mailing Address
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Address Line | 12900 W THUNDERBIRD RD
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City | EL MIRAGE
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State | AZ
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Zip | 85335-5945
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Country | US
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Telephone | 623-583-8920
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Fax | 623-583-8979
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | LDO-003235
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License Number State | AZ
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