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General NPI Number Information
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NPI Number | 1891896072
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Entity Type | Organization
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Legal Business Name | TEAGUE EYE CARE CENTER PA
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 04/26/2011
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Provider Practice Location Address
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Address Line | 1421 COUNTRY CLUB RD
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City | CAMDEN
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State | AR
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Zip | 71701-4507
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Country | US
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Telephone | 870-836-7319
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Fax | 870-836-7310
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Provider Business Mailing Address
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Address Line | PO BOX 953
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City | CAMDEN
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State | AR
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Zip | 71711-0953
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Country | US
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Telephone | 870-836-7319
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Fax | 870-836-7310
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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 | 870-836-7319
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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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