Organization
TERESA A. WISE, O.D., P.S.C.
Active
Other names
Wise Vision Care
Organization subpart
No
Provider details
NPI number
Authorized official
TERESA ANN WISE O.D. (PRESIDENT)
(270) 769-3708
Entity
Organization
Contact information
Practice address
2904 DOLPHIN DR, ELIZABETHTOWN, KY 42701-7102
(270) 769-3708
(270) 765-2043
Mailing address
2904 DOLPHIN DR, ELIZABETHTOWN, KY 42701-7102
(270) 769-3708
(270) 765-2043
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1156DT
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
770011567
—
KY
Enumeration date
07/15/2008
Last updated
07/15/2008
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