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General NPI Number Information
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NPI Number | 1114025665
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Entity Type | Individual
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Provider Name | TERRY N NULL OD
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 13840 E 96TH ST
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City | MCCORDSVILLE
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State | IN
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Zip | 46055-9394
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Country | US
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Telephone | 317-720-2020
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Fax | 317-458-1594
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Provider Business Mailing Address
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Address Line | 13840 E 96TH ST
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City | MCCORDSVILLE
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State | IN
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Zip | 46055-9394
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Country | US
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Telephone | 317-720-2020
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Fax | 317-458-1594
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18002112A
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License Number State | IN
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