Individual
DR. TENESHA A BAZEMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618000570
VA
152W00000X
Optometrist
1404-548T
LA
152W00000X
Optometrist
OE007871T
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
92-3420-9
—
VA
Enumeration date
01/22/2007
Last updated
11/09/2022
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