Provider Demographics
NPI:1730291170
Name:MCGUIRE, TERESA KRISTINE (OD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:KRISTINE
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:TERESA
Other - Middle Name:KRISTINE
Other - Last Name:LAFFOON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1722 BASHOR RD
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-1302
Mailing Address - Country:US
Mailing Address - Phone:574-533-4141
Mailing Address - Fax:
Practice Address - Street 1:116 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-3729
Practice Address - Country:US
Practice Address - Phone:574-533-7345
Practice Address - Fax:574-533-5683
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003031B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200239530AMedicaid
INU76725Medicare UPIN
IN229260EMedicare ID - Type Unspecified