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General NPI Number Information
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NPI Number | 1972358091
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Entity Type | Organization
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Legal Business Name | FAIRHOPE TERREZZA GROUP OD PC
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Dates
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Enumeration Date | 04/22/2024
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Last Update Date | 04/22/2024
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Provider Practice Location Address
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Address Line | 101 FLY CREEK AVE STE 305
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City | FAIRHOPE
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State | AL
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Zip | 36532-8310
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Country | US
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Telephone | 850-434-2060
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Fax | 850-429-8215
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Provider Business Mailing Address
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Address Line | 113 PALAFOX PL
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City | PENSACOLA
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State | FL
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Zip | 32502-5629
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Country | US
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Telephone | 850-434-2060
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Fax | 850-429-8215
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | JENNIFER J DUKES
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Credential |
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Telephone | 850-434-2060
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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 |
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License Number State |
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