Provider Demographics
NPI:1861872319
Name:TETEN, AMBER (OD)
Entity type:Individual
Prefix:DR
First Name:AMBER
Middle Name:
Last Name:TETEN
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 1:649 CEDAR RD STE 101
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-8315
Mailing Address - Country:US
Mailing Address - Phone:757-529-6889
Mailing Address - Fax:757-260-5533
Practice Address - Street 1:649 CEDAR RD STE 101
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-8315
Practice Address - Country:US
Practice Address - Phone:757-529-6889
Practice Address - Fax:757-260-5533
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-30
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002403152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist