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Provider Information for 1790737161

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

DR TERESA ENNIS-DECKER & ASSOCIATES

Organization Subpart: NO

Organization NPI: 1790737161

Calendar   Last Updated:  2013-01-17
  Certification Date: 

Details

Name Value
NPI 1790737161
Enumeration Date 2006-05-16
NPI Type 2- Organization
Status Active
Authorized Official Information Name: MRS. TERESA ENNIS-DECKER O.D.
Title: OWNER
Phone: 989-871-3559
Mailing Address 7925 SHERIDAN RD
MILLINGTON, MI 48746-9619
United States

Phone: 989-871-3559 | Fax:
View Map External Link
Primary Practice Address 4313 CORUNNA RD
FLINT, MI 48532-4152
United States

Phone: 810-733-5544 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 193400000X SINGLE SPECIALTY GROUP
152W00000X - Optometrist
MI 4901003316