Healthcare Provider Details

I. General information

NPI: 1588650568
Provider Name (Legal Business Name): THOMAS F TERRY OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 12/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 N MAIN ST
WHITE RIVER JUNCTION VT
05001-7056
US

IV. Provider business mailing address

128 N MAIN ST
WHITE RIVER JUNCTION VT
05001-7056
US

V. Phone/Fax

Practice location:
  • Phone: 802-295-3300
  • Fax: 802-295-6581
Mailing address:
  • Phone: 802-295-3300
  • Fax: 802-295-6581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number030-0000167
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: