Provider Demographics
NPI:1942457775
Name:TEAGUE, WILLIAM BAXTER (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BAXTER
Last Name:TEAGUE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4 S TUNNEL RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805-2237
Mailing Address - Country:US
Mailing Address - Phone:828-298-6500
Mailing Address - Fax:828-298-9108
Practice Address - Street 1:4 S TUNNEL RD
Practice Address - Street 2:SUITE 800
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805-2237
Practice Address - Country:US
Practice Address - Phone:828-298-6500
Practice Address - Fax:828-298-9108
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2831152W00000X
NC2124152W00000X
GAOPT002640152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5911445Medicaid
NC5911445Medicaid