Healthcare Provider Details

I. General information

NPI: 1255512133
Provider Name (Legal Business Name): TERRY SHEETS OPTICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9030 MONTGOMERY RD
CINCINNATI OH
45242-7741
US

IV. Provider business mailing address

9030 MONTGOMERY RD
CINCINNATI OH
45242-7741
US

V. Phone/Fax

Practice location:
  • Phone: 513-791-3336
  • Fax: 513-791-3352
Mailing address:
  • Phone: 513-791-3336
  • Fax: 513-791-3352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number2420SC
License Number StateOH

VIII. Authorized Official

Name: TERRY F. SHEETS
Title or Position: OWNER/MANAGER
Credential: L.D.O.
Phone: 513-791-3336