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General NPI Number Information
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NPI Number | 1346570256
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Entity Type | Organization
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Legal Business Name | TERESA BLACKSTONE OD PC
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Dates
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Enumeration Date | 12/29/2009
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Last Update Date | 12/29/2009
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Provider Practice Location Address
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Address Line | 414 MAPLE AVE STE 200
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City | SARATOGA SPRINGS
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State | NY
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Zip | 12866-5533
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Country | US
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Telephone | 518-597-0772
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Fax | 518-587-8749
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Provider Business Mailing Address
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Address Line | 414 MAPLE AVE STE 200
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City | SARATOGA SPRINGS
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State | NY
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Zip | 12866-5533
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Country | US
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Telephone | 518-597-0772
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Fax | 518-587-8749
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TERESA L BLACKSTONE
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Credential | O.D.
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Telephone | 518-580-9893
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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 | VUT004647
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License Number State | NY
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