Individual
DR. VAN M TEAGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
800 S STRATFORD RD, WINSTON SALEM, NC 27103-3202
(336) 765-5788
(336) 765-5584
Mailing address
800 S STRATFORD RD, WINSTON SALEM, NC 27103-3202
(336) 765-5788
(336) 765-5584
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1141
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09891
BCBSNC PROVIDER ID
NC
05
—
8909891
—
NC
Enumeration date
06/13/2006
Last updated
02/15/2008
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