Healthcare Provider Details

I. General information

NPI: 1780656819
Provider Name (Legal Business Name): TERRY L BONDS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 02/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 PELHAM RD S
JACKSONVILLE AL
36265-2745
US

IV. Provider business mailing address

601 PELHAM RD S
JACKSONVILLE AL
36265-2745
US

V. Phone/Fax

Practice location:
  • Phone: 256-435-9453
  • Fax: 256-435-9485
Mailing address:
  • Phone: 256-435-9453
  • Fax: 256-435-9485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS491-TA-015
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: