Provider Demographics
NPI:1902802911
Name:DR. GENE J.A. TERREZZA, O.D. & ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:DR. GENE J.A. TERREZZA, O.D. & ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:
Authorized Official - Last Name:TERREZZA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:850-623-0319
Mailing Address - Street 1:5593 STEWART ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-4344
Mailing Address - Country:US
Mailing Address - Phone:850-456-5059
Mailing Address - Fax:850-456-0461
Practice Address - Street 1:5593 STEWART ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-4344
Practice Address - Country:US
Practice Address - Phone:850-623-0319
Practice Address - Fax:850-626-9686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1196152W00000X
FLAS1903237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0503900002Medicare NSC
T54791Medicare UPIN
FLK4135Medicare PIN