Provider Demographics
NPI:1346226008
Name:BATAC, THERESA L (OD)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:L
Last Name:BATAC
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 1:612 HILLTOP WEST SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-6139
Mailing Address - Country:US
Mailing Address - Phone:757-491-1977
Mailing Address - Fax:
Practice Address - Street 1:612 HILLTOP WEST SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-6139
Practice Address - Country:US
Practice Address - Phone:757-491-1977
Practice Address - Fax:757-491-1136
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA601001676152WC0802X, 152WL0500X, 152WP0200X, 152WX0102X
VA0618000007152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
1801903745OtherGROUP NPI
VA9232559Medicaid
51-0558604OtherTAXID CORP
1801903745OtherGROUP NPI
51-0558604OtherTAXID CORP
TX410047734Medicare ID - Type UnspecifiedPALMETTO
VA410001132Medicare ID - Type UnspecifiedTRAILBLAZER