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General NPI Number Information
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NPI Number | 1790087864
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Entity Type | Organization
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Legal Business Name | TERILYN THACH, INC
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Dates
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Enumeration Date | 11/23/2010
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Last Update Date | 07/18/2011
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Provider Practice Location Address
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Address Line | 2419 E VALLEY PKWY
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City | ESCONDIDO
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State | CA
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Zip | 92027-2932
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Country | US
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Telephone | 760-738-9931
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Fax | 760-738-9933
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Provider Business Mailing Address
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Address Line | 2419 E VALLEY PKWY
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City | ESCONDIDO
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State | CA
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Zip | 92027-2932
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Country | US
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Telephone | 760-738-9931
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Fax | 760-738-9933
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. TERILYN THACH
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Credential | O.D.
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Telephone | 760-738-9931
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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 | 11456
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License Number State | CA
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