Organization
AUDIE M TEAGUE O D P A
Active
Other names
Teague Eye Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AUDIE M. TEAGUE O.D. (PRESIDENT)
(870) 887-3596
Entity
Organization
Contact information
Practice address
204 E 2ND SREET S, PRESCOTT, AR 71857
(870) 887-3596
(870) 887-3945
Mailing address
PO BOX 189, PRESCOTT, AR 71857-0189
(870) 887-3596
(870) 887-3945
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2325
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112122722
—
AR
01
—
410011556
RAILROAD MEDICARE
AR
Enumeration date
10/18/2006
Last updated
08/14/2008
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