MEDICARE: DR. TERRY W ELLINGTON O.D.

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	1902	NC

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

General Provider Information

NPI Number	:	1093719080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRY W ELLINGTON O.D.

Provider Business Mailing Address
First Line	:	8013 N POINT BLVD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27106-3203
Country	:	US
Telephone Number	:	336-775-1734
Fax Number	:	336-775-1734

Provider Business Practice Location Address
First Line	:	8013 N POINT BLVD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27106-3203
Country	:	US
Telephone Number	:	336-775-1734
Fax Number	:	336-775-1734

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	11/10/2025

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