MEDICARE: DR. TERRY H. WYNNE, OPTOMETRIST, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1871762823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. TERRY H. WYNNE, OPTOMETRIST, P.C.

Provider Business Mailing Address
First Line	:	112 W OAK ST
Second Line	:
City	:	GRIFFIN
State	:	GA
Zip	:	30224-4233
Country	:	US
Telephone Number	:	770-227-2924
Fax Number	:	770-227-2937

Provider Business Practice Location Address
First Line	:	112 W OAK ST
Second Line	:
City	:	GRIFFIN
State	:	GA
Zip	:	30224-4233
Country	:	US
Telephone Number	:	770-227-2924
Fax Number	:	770-227-2937

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. TERRY H. WYNNE
Credential	:
Telephone Number	:	770-227-2924

Provider Enumeration Date	:	02/25/2008
Last Update Date	:	09/28/2010

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