MEDICARE: SHERRIE D TEDDY ODPA

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	OPC1797	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0482470001	OTHER	FL	P TAN

General Provider Information

NPI Number	:	1700954351
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHERRIE D TEDDY ODPA

Provider Business Mailing Address
First Line	:	2740 SEVEN SPRINGS BLVD
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-3623
Country	:	US
Telephone Number	:	727-372-0414
Fax Number	:	727-372-9313

Provider Business Practice Location Address
First Line	:	2740 SEVEN SPRINGS BLVD
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-3623
Country	:	US
Telephone Number	:	727-372-0414
Fax Number	:	727-372-9313

Authorized Official
Title or Position	:	OWNER
Name	:	SHERRIE D TEDDY
Credential	:	O.D.
Telephone Number	:	727-372-0414

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	12/15/2014

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Directions to “SHERRIE D TEDDY ODPA ” Practice Location

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