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General NPI Number Information
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NPI Number | 1851091805
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Entity Type | Organization
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Legal Business Name | TEDDER OPTOMETRIC CLINIC MANAGEMENT, P.C.
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Dates
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Enumeration Date | 03/08/2023
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 17064 SLOVER AVE STE 104
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City | FONTANA
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State | CA
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Zip | 92337-7592
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Country | US
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Telephone | 909-258-4620
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Fax |
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Provider Business Mailing Address
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Address Line | 530 NEW LOS ANGELES AVE STE 115-269
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City | MOORPARK
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State | CA
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Zip | 93021-2081
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Country | US
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Telephone | 805-624-1255
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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. TAYLOR DEAN TEDDER
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Credential | OD
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Telephone | 805-624-1255
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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 |
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License Number State |
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