MEDICARE: DR. TERESA A MAYHEW-SUTHERLAND O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	ODP-778	ID
2	152W00000X	Optometrist	8802T	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265404180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERESA A MAYHEW-SUTHERLAND O.D.

Provider Business Mailing Address
First Line	:	5434 CARPINTERIA AVE
Second Line	:
City	:	CARPINTERIA
State	:	CA
Zip	:	93013-1423
Country	:	US
Telephone Number	:	805-684-5476
Fax Number	:	805-684-5477

Provider Business Practice Location Address
First Line	:	127 SANTO TOMAS LN
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93108-2516
Country	:	US
Telephone Number	:	805-565-2006
Fax Number	:	805-565-2006

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	03/14/2019

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