Wise, Teresa Ann

Wise, Teresa Ann is an sole proprietor health care provider with primary practice located at 2904 Dolphin Dr , Elizabethtown KY 42701-7102. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Wise, Teresa Ann can be contacted via phone (270) 769-3708.

Contact Information

Primary practice address
2904 Dolphin Dr Elizabethtown KY 42701-7102
Phone: (270) 769-3708
Fax: (270) 765-2043
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 1156DT Kentucky

Profile Details

NPI number 1114076288
LBN Legal business name Wise, Teresa Ann
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 9th, 2007
Last updated May 13th, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114076288 NPPES
Kentucky MEDICAID 77-0011567
Kentucky MEDICAID 770011567

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