MEDICARE: TERRY L TUCKER OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2000	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033100060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRY L TUCKER OD

Provider Business Mailing Address
First Line	:	88 PINE ISLAND RD
Second Line	:	SUITE 3
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33903-3745
Country	:	US
Telephone Number	:	239-656-1778
Fax Number	:	239-656-5858

Provider Business Practice Location Address
First Line	:	88 PINE ISLAND RD
Second Line	:	SUITE 3
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33903-3745
Country	:	US
Telephone Number	:	239-656-1778
Fax Number	:	239-656-5858

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	06/02/2008

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