MEDICARE: TEUNIS VISION CENTER

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	TA0996	MD

General Provider Information

NPI Number	:	1386702082
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEUNIS VISION CENTER

Provider Business Mailing Address
First Line	:	16819 CRABBS BRANCH WAY
Second Line	:
City	:	DERWOOD
State	:	MD
Zip	:	20855-2215
Country	:	US
Telephone Number	:	301-948-9171
Fax Number	:	301-926-1432

Provider Business Practice Location Address
First Line	:	16819 CRABBS BRANCH WAY
Second Line	:
City	:	DERWOOD
State	:	MD
Zip	:	20855-2215
Country	:	US
Telephone Number	:	301-948-9171
Fax Number	:	301-926-1432

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT HUYETT TEUNIS JR.
Credential	:	O.D.
Telephone Number	:	301-948-9171

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	02/07/2012

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