=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346277548
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SCOTT TEUSCHER O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 315 STATE HIGHWAY 202
-----------------------------------------------------
City | FLEMINGTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08822-1700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-788-5777
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 520 BELLWOOD PARK RD
-----------------------------------------------------
City | ASBURY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08802-1209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-479-1438
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 27OA00469000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------