Provider Demographics
NPI:1265404180
Name:MAYHEW-SUTHERLAND, TERESA A (OD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:A
Last Name:MAYHEW-SUTHERLAND
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:TERESA
Other - Middle Name:ANN
Other - Last Name:MAYHEW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:5434 CARPINTERIA AVE
Mailing Address - Street 2:
Mailing Address - City:CARPINTERIA
Mailing Address - State:CA
Mailing Address - Zip Code:93013-1423
Mailing Address - Country:US
Mailing Address - Phone:805-684-5476
Mailing Address - Fax:805-684-5477
Practice Address - Street 1:127 SANTO TOMAS LN
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93108-2516
Practice Address - Country:US
Practice Address - Phone:805-565-2006
Practice Address - Fax:805-565-2006
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-778152W00000X
CA8802T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0088020Medicaid
CASD008802Medicaid
CAOP8802Medicare PIN