NPIMap

Organization Active NPI

Randall L Teague OD PA

Doing business as Teague Vision Clinic

  • Optometrist
  • Little Rock, AR
National Provider Identifier
1558677476
Registry record updated Aug 30, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2254 Issued in AR
Legal business name
RANDALL L TEAGUE OD PA
Doing business as
Teague Vision Clinic
Practice address
11115 Hermitage Rd
Little Rock, AR 72211-3807
Phone
(501) 224-7056
Fax
(501) 224-4327
NPI assigned
Aug 30, 2010
Last updated
Aug 30, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2010

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

Authorized official

Name
Dr. Randall L Teague, O.D.NPI 1588687602
Title
Optometrist / Owner
Phone
(501) 224-7056

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 2254 AR Primary

Addresses

Primary practice location

11115 Hermitage Rd
Little Rock, AR 72211-3807

Mailing address

11115 Hermitage Rd
Little Rock, AR 72211-3807
Phone (501) 224-7056

Other identifiers 1

IdentifierTypeStateIssuer
105488722MedicaidAR

Other names 1

  • Teague Vision Clinic Doing business as

National Provider Directory

National Provider Directory

Locations

11115 Hermitage Rd
Little Rock, AR 72211
Phone (501) 224-7056

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1283126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283126400000",
    "number": "1558677476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11115 HERMITAGE RD",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722113807",
            "telephone_number": "501-224-7056",
            "fax_number": "501-224-4327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11115 HERMITAGE RD",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722113807",
            "telephone_number": "501-224-7056",
            "fax_number": "501-224-4327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RANDALL L TEAGUE OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-30",
        "last_updated": "2010-08-30",
        "status": "A",
        "authorized_official_last_name": "TEAGUE",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OPTOMETRIST / OWNER",
        "authorized_official_telephone_number": "501-224-7056",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "AR",
            "license": "2254",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "105488722",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Teague Vision Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Little Rock, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.