Provider Demographics
NPI:1487976072
Name:LIFETIME EYE CARE C. HOUSTON TEATERS, OD, PC
Entity type:Organization
Organization Name:LIFETIME EYE CARE C. HOUSTON TEATERS, OD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:H
Authorized Official - Last Name:TEATERS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:540-392-9020
Mailing Address - Street 1:615 DEE DEE DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073
Mailing Address - Country:US
Mailing Address - Phone:540-392-9020
Mailing Address - Fax:
Practice Address - Street 1:2851 CARROLLTON PIKE
Practice Address - Street 2:SUITE A
Practice Address - City:WOODLAWN
Practice Address - State:VA
Practice Address - Zip Code:24381
Practice Address - Country:US
Practice Address - Phone:276-236-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000913152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty