Individual
TERESA ROBERTSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
478 MCQUEEN SMITH RD S, PRATTVILLE, AL 36066-5631
(334) 365-9911
Mailing address
478 MCQUEEN SMITH RD S, PRATTVILLE, AL 36066-5631
(334) 365-9911
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009948105
—
AL
Enumeration date
10/31/2008
Last updated
10/31/2008
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