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General NPI Number Information
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NPI Number | 1588751721
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Entity Type | Organization
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Legal Business Name | CARLA R. TESO, OD, PC, INC
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Dates
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Enumeration Date | 10/09/2006
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Last Update Date | 03/21/2011
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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 | 47909-9183
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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 | 2224 DREXEL DR
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City | LAFAYETTE
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State | IN
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Zip | 47909-3903
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Country | US
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Telephone | 765-471-8588
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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. CARLA RENEE TESO
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Credential | O.D.
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Telephone | 765-471-8588
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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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