Healthcare Provider Details

I. General information

NPI: 1902802911
Provider Name (Legal Business Name): GENE TERREZZA OD AND ASSOCIATES.,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5593 STEWART ST
MILTON FL
32570-4344
US

IV. Provider business mailing address

5593 STEWART ST
MILTON FL
32570-4344
US

V. Phone/Fax

Practice location:
  • Phone: 850-623-0319
  • Fax: 850-626-9686
Mailing address:
  • Phone: 850-456-5059
  • Fax: 850-456-0461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC1196
License Number StateFL

VIII. Authorized Official

Name: JENNIFER DUKES
Title or Position: BILLING MANAGER
Credential:
Phone: 850-434-2060