Healthcare Provider Details

I. General information

NPI: 1730074469
Provider Name (Legal Business Name): ISABELLA SUSANNE TERRY OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 CIVIC DR STE G
PLEASANT HILL CA
94523-1950
US

IV. Provider business mailing address

54 ALAN DR
PLEASANT HILL CA
94523-1902
US

V. Phone/Fax

Practice location:
  • Phone: 925-676-8365
  • Fax:
Mailing address:
  • Phone: 925-852-1672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number36006
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: