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General NPI Number Information
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NPI Number | 1790737161
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Entity Type | Organization
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Legal Business Name | DR TERESA ENNIS-DECKER & ASSOCIATES
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 01/17/2013
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Provider Practice Location Address
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Address Line | 4313 CORUNNA RD
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City | FLINT
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State | MI
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Zip | 48532-4152
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Country | US
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Telephone | 810-733-5544
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Fax |
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Provider Business Mailing Address
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Address Line | 7925 SHERIDAN RD
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City | MILLINGTON
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State | MI
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Zip | 48746-9619
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Country | US
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Telephone | 989-871-3559
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. TERESA ENNIS-DECKER
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Credential | O.D.
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Telephone | 989-871-3559
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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 | 4901003316
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License Number State | MI
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