Provider Demographics
NPI:1548811938
Name:TENEYCKE, KELSEY (OD)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:TENEYCKE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 N MCKEMY AVE
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-2651
Mailing Address - Country:US
Mailing Address - Phone:480-961-1865
Mailing Address - Fax:
Practice Address - Street 1:9160 S HOUGHTON RD STE 140
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-9736
Practice Address - Country:US
Practice Address - Phone:520-574-6513
Practice Address - Fax:520-798-7337
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOPT-002392152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist