1265404180 NPI number — DR. TERESA A MAYHEW-SUTHERLAND O.D.

Table of content: DR. TERESA A MAYHEW-SUTHERLAND O.D. (NPI 1265404180)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265404180 NPI number — DR. TERESA A MAYHEW-SUTHERLAND O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAYHEW-SUTHERLAND
Provider First Name:
TERESA
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MAYHEW
Provider Other First Name:
TERESA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1265404180
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5434 CARPINTERIA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARPINTERIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93013-1423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-684-5476
Provider Business Mailing Address Fax Number:
805-684-5477

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
127 SANTO TOMAS LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA BARBARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93108-2516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-565-2006
Provider Business Practice Location Address Fax Number:
805-565-2006
Provider Enumeration Date:
02/03/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  ODP-778 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 8802T , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: SD0088020 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: SD008802 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".