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General NPI Number Information
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NPI Number | 1487976072
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Entity Type | Organization
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Legal Business Name | LIFETIME EYE CARE C. HOUSTON TEATERS, OD, PC
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Dates
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Enumeration Date | 02/23/2010
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Last Update Date | 02/23/2010
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Provider Practice Location Address
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Address Line | 2851 CARROLLTON PIKE SUITE A
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City | WOODLAWN
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State | VA
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Zip | 24381
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Country | US
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Telephone | 276-236-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 615 DEE DEE DRIVE
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City | CHRISTIANSBURG
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State | VA
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Zip | 24073
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Country | US
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Telephone | 540-392-9020
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES H TEATERS
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Credential | OD
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Telephone | 540-392-9020
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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 | 0618000913
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License Number State | VA
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