=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902802911
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GENE TERREZZA OD AND ASSOCIATES.,PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2005
-----------------------------------------------------
Last Update Date | 11/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5593 STEWART ST
-----------------------------------------------------
City | MILTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32570-4344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-623-0319
-----------------------------------------------------
Fax | 850-626-9686
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5593 STEWART ST
-----------------------------------------------------
City | MILTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32570-4344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-456-5059
-----------------------------------------------------
Fax | 850-456-0461
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MANAGER
-----------------------------------------------------
Name | JENNIFER DUKES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 850-434-2060
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPC1196
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------