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General NPI Number Information
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NPI Number | 1164446597
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Entity Type | Individual
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Provider Name | CARLA RENEE TESO O.D.
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Gender | Female
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 2347 VETERANS MEMORIAL PKWY S
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City | LAFAYETTE
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State | IN
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Zip | 47909-9399
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Country | US
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Telephone | 765-477-9395
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Fax | 765-477-9397
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Provider Business Mailing Address
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Address Line | 4789 MASONS RIDGE RD
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City | LAFAYETTE
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State | IN
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Zip | 47909-8425
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Country | US
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Telephone | 765-430-7533
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Fax | 765-477-9397
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18003098
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License Number State | IN
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