Individual provider Active NPI

Kelsey Teneycke, OD

  • Optometrist
  • Tucson, AZ
National Provider Identifier
1548811938
Registry record updated Sep 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT-002392 Issued in AZ
Practice address
9160 S Houghton Rd Ste 140
Tucson, AZ 85747-9736
Phone
(520) 574-6513
Fax
(520) 798-7337
NPI assigned
Sep 26, 2019
Last updated
Sep 26, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT-002392 AZ Primary

Addresses

Primary practice location

9160 S Houghton Rd Ste 140
Tucson, AZ 85747-9736

Mailing address

220 N McKemy Ave
Chandler, AZ 85226-2651
Phone (480) 961-1865

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191030000741 AZ Practitioner - Optometry 3274865969 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPT-002392AZMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Michael Zucker OD PC Optometrist CurrentSince Jul 1, 2022 Accepting new patients

Locations

6843 N Oracle Rd
Tucson, AZ 85704
Phone (520) 219-5080

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1569456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569456000000",
    "number": "1548811938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 N MCKEMY AVE",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852262651",
            "telephone_number": "480-961-1865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9160 S HOUGHTON RD STE 140",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857479736",
            "telephone_number": "520-574-6513",
            "fax_number": "520-798-7337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TENEYCKE",
        "first_name": "KELSEY",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-26",
        "last_updated": "2019-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "OPT-002392",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

Verify at the official NPI Registry.