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General NPI Number Information
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NPI Number | 1699856278
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Entity Type | Organization
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Legal Business Name | AUDIE M TEAGUE O D P A
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 08/14/2008
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Provider Practice Location Address
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Address Line | 204 E 2ND SREET S
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City | PRESCOTT
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State | AR
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Zip | 71857
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Country | US
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Telephone | 870-887-3596
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Fax | 870-887-3945
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Provider Business Mailing Address
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Address Line | PO BOX 189
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City | PRESCOTT
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State | AR
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Zip | 71857-0189
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Country | US
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Telephone | 870-887-3596
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Fax | 870-887-3945
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AUDIE M. TEAGUE
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Credential | O.D.
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Telephone | 870-887-3596
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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 | 2325
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License Number State | AR
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