Provider Demographics
NPI:1053084129
Name:FREY, TEESHA DARLENE (OD)
Entity type:Individual
Prefix:
First Name:TEESHA
Middle Name:DARLENE
Last Name:FREY
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 1:6401 RIALTO BLVD APT 334
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-0029
Mailing Address - Country:US
Mailing Address - Phone:563-379-5914
Mailing Address - Fax:
Practice Address - Street 1:925 STARWOOD DR
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-9099
Practice Address - Country:US
Practice Address - Phone:512-327-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10347T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist