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General NPI Number Information
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NPI Number | 1255351755
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Entity Type | Individual
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Provider Name | GREGORY CLIFTON TESLUK MD
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Gender | Male
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 400 E ORANGEBURG AVE STE 2
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City | MODESTO
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State | CA
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Zip | 95350-5365
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Country | US
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Telephone | 209-526-3000
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Fax | 209-526-3133
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Provider Business Mailing Address
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Address Line | 3424 WYCLIFFE DR
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City | MODESTO
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State | CA
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Zip | 95355-4742
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Country | US
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Telephone | 209-526-5121
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Fax |
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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 | 156FX1100X
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Taxonomy Name | Ophthalmic Technician/Technologist
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License Number | C41824
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | C418240
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License Number State | CA
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