Provider Demographics
NPI:1164446597
Name:TESO, CARLA RENEE (OD)
Entity type:Individual
Prefix:DR
First Name:CARLA
Middle Name:RENEE
Last Name:TESO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4789 MASONS RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47909-8425
Mailing Address - Country:US
Mailing Address - Phone:765-430-7533
Mailing Address - Fax:765-477-9397
Practice Address - Street 1:2347 VETERANS MEMORIAL PKWY S
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47909-9399
Practice Address - Country:US
Practice Address - Phone:765-477-9395
Practice Address - Fax:765-477-9397
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003098152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU85565Medicare UPIN
IN199270Medicare PIN