Healthcare Provider Details

I. General information

NPI: 1295929933
Provider Name (Legal Business Name): GENE TERREZZA O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 PALAFOX PL
PENSACOLA FL
32502-5629
US

IV. Provider business mailing address

800 N FAIRFIELD DR
PENSACOLA FL
32506-4313
US

V. Phone/Fax

Practice location:
  • Phone: 850-456-5059
  • Fax: 850-456-0461
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:
Title or Position:
Credential:
Phone: