MEDICARE: DR. JACK E TERRY O.D., PH.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	1469	NC
2	152W00000X	Optometrist	5608	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	057645	OTHER	NC	OE TRACKER

General Provider Information

NPI Number	:	1801340526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACK E TERRY O.D., PH.D.

Provider Business Mailing Address
First Line	:	200 S COLLEGE ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28202-2012
Country	:	US
Telephone Number	:	704-887-0824
Fax Number	:	704-332-9568

Provider Business Practice Location Address
First Line	:	200 S COLLEGE ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28202-2012
Country	:	US
Telephone Number	:	704-887-0824
Fax Number	:	704-332-9568

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

Provider Enumeration Date	:	08/10/2016
Last Update Date	:	08/10/2016

Similar Medicare Providers

1588698229 — TRACELA VADEN MD
Practice Location Address:

200 S COLLEGE ST , STE 500
CHARLOTTE, NC
28202-2012

Practice Phone: 704-302-8800
Practice Fax:

1063431997 — ASHLEY DUNIGAN PA
Practice Location Address:

200 S COLLEGE ST , STE 500
CHARLOTTE, NC
28202-2012

Practice Phone: 704-302-8800
Practice Fax:

1609946870 — MOLLY FORTNER MD
Practice Location Address:

200 S COLLEGE ST , STE 500
CHARLOTTE, NC
28202-2012

Practice Phone: 704-302-8800
Practice Fax:

1124293881 — JENIFER INGLE
Practice Location Address:

200 S COLLEGE ST , SUITE 500
CHARLOTTE, NC
28202-2012

Practice Phone: 704-302-8800
Practice Fax: 704-632-4001

1962728923 — MECKLENBURG MEDICAL GROUP
Practice Location Address:

200 S COLLEGE ST , STE 500
CHARLOTTE, NC
28202-2012

Practice Phone: 704-302-8800
Practice Fax:

1043696701 — MEREDITH HACKLEY
Practice Location Address:

200 S COLLEGE ST
CHARLOTTE, NC
28202-2012

Practice Phone: 704-443-4444
Practice Fax:

Directions to “ DR. JACK E TERRY O.D., PH.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.