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NPI Code Detail

MEDICARE: TENESHA A BAZEMORE O.D.P.C.

MEDICARE: TENESHA A BAZEMORE O.D.P.C.
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
1152W00000XOptometrist0618000570VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11548314388OTHERVANPI

General Provider Information

NPI Number : 1487168027
Entity Type Code : Organization
Provider Name (Legal Business Name) : TENESHA A BAZEMORE O.D.P.C.
Provider Business Mailing Address
First Line : PO BOX 1612
Second Line :
City : NORFOLK
State : VA
Zip : 23501-1612
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6111 JEFFERSON AVE
Second Line :
City : NEWPORT NEWS
State : VA
Zip : 23605-1511
Country : US
Telephone Number : 757-470-0789
Fax Number :
Authorized Official
Title or Position : DR./OWNER
Name : DR. TENESHA BAZEMORE
Credential : O.D.
Telephone Number : 757-470-0789
Provider Enumeration Date : 11/17/2017
Last Update Date : 11/17/2017

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